Interventional Techniques for the Ablation and Augmentation of Extraspinal Lytic Bone Metastases

Abstract

In addition to being a major source of cancer-related pain, metastatic osseous lesions are frequently at risk for pathologic fracture and its accompanying morbidity. While bony metastases are commonly thought of as occurring within the vertebral column, over 80% are found outside the spine. Percutaneous interventional treatment options for nonspinal metastases offer a broad array of minimally invasive, image-guided procedures that are rapidly effective, reduce the need for opioids, and often work in complementary fashion with adjunct treatments in radiation oncology, orthopaedic surgery, and/or medical oncology. This article presents an approach to assess extraspinal metastases, reviews available interventional techniques in use today, and offers example cases as an introductory primer to the thought process used for selecting the appropriate interventional treatment.

Common Pitfalls in the Management of Bone Metastasis of the Extremities - a Current Concept and Systematic Review of the Literature

“…Disease-specific treatment. Metastatic bone disease in patients with pathological fractures should be managed by a multidisciplinary team including oncologists, radiotherapists, surgeons, and physical therapists (20,23,38,40). In addition to tumor type, treatment strategy for bony metastasis depends on the clinical features and includes further treatment options in addition to surgery (22).…”

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review

“…Differently from other interventional procedures aimed at tumor destruction, cementoplasty is a stabilization technique and it is used to consolidate the bone whose trabecular structure is weakened by a tumor, in order to reduce pain by the mechanical consolidation of fractured or pre-fractured bone [ 7 ]. Considering it has no effect on tumor growth progression, it can be performed alone with purely palliative intent, or as a complementary stabilization technique associated with other ablative treatments [ 139 , 140 , 141 , 142 ].…”

Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases

“…Cementoplasty may also be performed in nonweight-bearing skeletal sites such as the posterior iliac bone when mechanical pain is present. In extraspinal skeletal metastases, cementoplasty is commonly performed to achieve mechanical reinforcement of the acetabular roof and restoration of gravitational load transmission across the acetabulum 36,37,[40][41][42]44,63 (►Fig. 2).…”

“…During the past two decades, there have been substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions for the management of patients with musculoskeletal metastases including thermal ablations, cementation with or without osseous reinforcement via implants, osteosynthesis, neurolysis, and palliative injections, 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 which are increasingly incorporated in clinical practice and are performed, in conjunction with or supplemented by adjuvant radiation therapy, chemotherapy, or surgery, to achieve pain palliation, local tumor control, or cure (in cases of oligometastatic disease). This incorporation is supported by safety, high clinical success rate to achieve timely and durable pain palliation, strong local tumor control rates, reinforcement of the treated bone, as well as short- and long-term improvement in patient outcomes.…”

“…This incorporation is supported by safety, high clinical success rate to achieve timely and durable pain palliation, strong local tumor control rates, reinforcement of the treated bone, as well as short- and long-term improvement in patient outcomes. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 The National Comprehensive Cancer Network (NCCN) and American College of Radiology (ACR) have recently endorsed and incorporated this minimally invasive interventions in treatment guidelines of patients with musculoskeletal metastases. 50 51…”