Microwave Ablation of Primary Malignant Pelvic Bone Tumors

Abstract

Background: En bloc tumor resection followed by reconstruction is a widely used surgical treatment for malignant pelvic bone tumors. High rates of complications and mechanical instability often contribute to poor postoperative results. We attempted en bloc microwave ablation (MWA) in situ to improve the outcome.Methods: From May 1995 to December 2015, 104 patients with primary pelvic malignancy received radical MWA in our department. After careful dissection of the tumor-bearing bone from surrounding normal tissues with safe margins, a microwave antenna array was inserted into the tumor mass to emit electromagnetic energy, inducing tumor cellular death via thermocoagulation. The loose, devitalized tumor tissues were removed by cutting or curettage, leaving a defective bone scaffold. Re-strengthening by autograft or allograft was needed in most patients.Results: The over 3 years survival rate was 51.5% for high-grade malignancies (among them, 26.9% were osteosarcoma) and 94.8% for low-grade malignancies (chondrosarcoma). In most of the living patients, cosmetic and useful limbs were preserved. The mean functional score (Musculoskeletal Tumor Society) was 27 or 90% (range: 25–30, 75–100%). Among the 56 patients who belonged to the excellent function group, 11 were followed up for more than 10 years. The local recurrence rate was 8.6%. Among the 9 patients with recurrence, 5 died from disease, 2 were treated by hemipelvic amputation, and 2 underwent revision surgery with MWA and gained local control. The deep infection rate was 5.6%. All six patients with infection were healed by irrigation, debridement, and systemic antibiotic administration.Conclusion: Local, microwave-induced hyperthermia for treating malignant pelvic bone tumors is an effective alternative method. The oncological and functional results are encouraging. The use of MWA should be continued to evaluate and improve this new therapeutic system.

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“…Pelvic osteosarcomas often are diagnosed later and with bigger volume than the ones occurring in long bones due to the fact that they are deeply located. To make it worse, pelvic osteosarcomas did not seem to respond well to neoadjuvant chemotherapy and the survival was more dismal than the ones in long bones ( 13 , 14 ). In fact, Guo et al suggested in one study that neo-chemotherapy does not seem to improve overall survival in pelvic osteosarcoma ( 15 ), which supported our decision to agree to discontinue neoadjuvant chemotherapy when the patient showed poor tolerance.…”

Evaluation of microwave ablation for local treatment of dogs with distal radial osteosarcoma: A pilot study

“…Human patients undergoing limb‐sparing procedures are faced with similar complications; however, improved complication rates were achieved in some studies when MWA was used. 34,35 Fan et al 34 evaluated 104 people with primary pelvic bone tumors that underwent MWA of the lesion followed by reconstruction with autograft or allograft and bone cement. In those human patients, the local recurrence was 8.6%, and the infection rate was 5.6%, which is lower than the recurrence rate (21% to 38%) and infection rate (21% to 28%) reported with surgical en bloc resection.…”

“…The temperature of adjacent soft tissues is maintained below 39°C. To treat the surgical margins in this pilot study, we placed the ablation probe so that the ablation zone would extend 1 to 2 cm beyond the margin of the tumor 22,23,34,35 . We placed the ablation probe to the most proximal aspect of the tumor in our study.…”

Use of percutaneous microwave ablation for the treatment of bone tumors: a retrospective study of clinical outcomes in 47 patients

“…It seems possible that endoscopic MWA combined with BC can be performed through safe and short ablation cycles to control the diffusion of the heating zone without damaging vital nerves or blood vessels. Recently, Fan et al [28] attempted en bloc MWA in situ to improve the outcome of the treatment of primary malignant pelvic bone tumors, with encouraging oncological and functional results. Our results are consistent with those of previous studies, with immediate pain reduction and quality of life improvement obtained in almost 100% of the patients and maintained at the final follow-up visit.…”