Roxanne Nelson

March 12, 2009

March 12, 2009 (San Diego, California) — For patients with painful bone metastases and benign lytic lesions that do not respond to conventional analgesic therapy, percutaneous osteoplasty might be an option. Data presented here at the Society of Interventional Radiology (SIR) 34th Annual Scientific Meeting show that the procedure can provide immediate and substantial pain relief in this population.

The case summary presented demonstrated rapid relief in 81 patients with intractable bone pain. The average pain-intensity score, based on an 11-point visual analog scale (VAS), dropped significantly, from 8.8 ± 1.4 to 1.8 ± 2.1 within 24 hours of receiving osteoplasty. Researchers also reported that 64 of the patients (79%) were able to stop taking narcotic drugs for pain, and 43 (53%) were able to suspend analgesic therapy.

"This series is important because it validates what many of us are seeing — that these procedures can make a remarkable difference," said Brian Stainken, MD, president-elect of SIR, in an interview. "An increasing number of centers, both in the United States and abroad, are using these techniques."

Dr. Stainken, who was not involved in the study, explained that this procedure is similar to vertebroplasty, an interventional radiology treatment that has been used extensively to treat pain caused by compression fractures in the spine. "These concepts have been extrapolated to other processes in the body," he said, "and we found that they can be quite effective in relieving bone pain caused by cancer metastases. This study should encourage more widespread use of this palliative intervention, and make physicians more aware of this treatment option."

Bone is one of the most frequent sites of cancer metastases, and can develop in conjunction with a number of malignancies, including tumors of the breast, bladder, kidney, and lung. Quality of life can be severely affected by metastatic bone disease; many patients report alterations in sleep patterns and poor appetite, and the need for pain medication increases, explained study author Giovanni C. Anselmetti, MD, interventional radiologist at the Institute for Cancer Research and Treatment, in Turin, Italy.

Not First Line, But Highly Effective

However, he emphasized that osteoplasty is not a first-line treatment for painful bone metastases. "It is a highly effective minimally invasive procedure that provides pain relief for patients not responding to conventional pain medication treatments," he said. "Chemotherapy, radiotherapy, bisphosphonates, and analgesic treatment leave approximately one third of cases with inadequate or undermanaged pain control. This is a novel treatment that offers new options to these patients."

The study involved 81 patients with painful extraspinal lytic lesions due to benign or metastatic diseases, although the majority (74 patients) were caused by malignancies. Level of pain was evaluated using the VAS (0 to 10) before and after the procedure. A reduction of 2 or more points represented a clinically important difference, the researchers note.

A total of 111 lesions were treated. Six patients underwent a second procedure: 5 for the occurrence of a new painful lytic lesion and 1 for the relapse of symptoms. A preliminary radiofrequency thermal ablation was performed in 7 patients affected by large metastases to reduce the tumoral bulk, and 1 patient had undergone a previous cryoablation for the same reason. All of the procedures were performed under fluoroscopic guidance, primarily in combination with computed tomography, and the treated bones were mainly proximal femur, sacrum, and pelvic bones. In some patients, the foot, metacarpal bone, ribs, scapulae, and humeral head were also treated.

Only 5 patients (6.1%) did not experience an improvement in pain. The average follow-up was 11.2 ± 6.2 months (range, 3to 36 months), and the researchers observed that the reduced VAS score lasted, indicating that the procedure provided long-term relief for most patients.

Not Recommended for Femoral Shaft

Percutaneous osteoplasty was found to be safe overall, and no deaths or major complications occurred during the procedure. However, the researchers caution that the procedure is not suitable for use on femur lesions.

Two patients who underwent the procedure on the femoral shaft for lytic metastases experienced a pathologic fracture at the treatment site (on day 18 and 31). The researchers concluded that bone consolidation cannot be safely obtained in the femoral diaphysis using poly(methyl-methacrylate), which is injected into the lesion during osteoplasty.

"In our experience, it is not possible to treat the femoral shaft," said Dr. Anselmetti. "This may change in the future when new types of bone cement come on the market."

The procedure is simple and can easily be performed by interventional radiologists, he added. "The clinical outcome is that we can offer patients immediate long-term relief, and we can decrease the use of analgesics that most of these patients are obliged to use."

Society of Interventional Radiology (SIR) 34th Annual Scientific Meeting: Abstract 36. Presented March 9, 2009.


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