Pelvic Osteoplasty in Osteolytic Metastases: Technical Approach under Fluoroscopic Guidance and Early Clinical Results

Kelekis, Alexis; Lövblad, Karl-Olof; Mehdizade, A.; Somon, Thierry; Yılmaz, Hasan; Wetzel, Stefan G.; Seium, Yodit; Dietrich, Pierre‐Yves; Rüfenacht, Daniel A.; Martin, Jean-Baptiste

doi:10.1097/01.rvi.0000141717.84515.92

Cited by 98 publications

(69 citation statements)

References 12 publications

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“…The patients were then transferred to the angiography suite for cement injection under direct fluoroscopy guidance. 17 CTguided fluoroscopy has also been described in vertebroplasty from metastatic diseases. 18 This study has demonstrated that percutaneous cementation of sacral and pelvic metastases under CT or fluoroscopy guidance is a safe, effective, and feasible procedure that provides short-term pain relief.…”

Section: Discussionmentioning

confidence: 99%

“…16 I believe that this technique can be used for focal lesions in the sacral alae if the tumors are contained inside the bone with no soft tissue extension and there is no involvement of important structures such as the neural foramina. Kelekis et al 17 has described percutaneous fluoroscopy-guided techniques for an osteoplasty of the superior and inferior pubic rami and ischial tuberosity in 14 patients. Sacroplasty for sacral insufficiency fractures has been described by placing the needles under CT guidance.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Cement Augmentations of Malignant Lesions of the Sacrum and Pelvis: Fig 1.

Georgy¹

2009

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Although cement augmentation has been described in the literature for the treatment of benign sacral insufficiency fractures, only a few case reports have described the procedure's usage in the treatment of malignant lesions. The purpose of this study was to evaluate the feasibility, effectiveness, safety, and clinical outcome for percutaneous cement augmentation of patients with malignant lesions in the sacrum and pelvis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Percutaneous Cement Augmentations of Malignant Lesions of the Sacrum and Pelvis: Fig 1.

Georgy¹

2009

AJNR Am J Neuroradiol

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“…Since the first report of percutaneous vertebralplasty appeared in 1987 [9], such techniques gained wide application in the treatment of osteoporotic compression, osteolytic metastases, and hemangioma of vertebrae. In recent years, percutaneouos osteoplasty as a technical extension of the vertebroplasty has been included in the treatment of osteolytic lesions in weight-bearing besides the vertebrae, including acetabulum, sacrum, pubis, pelvis, ischium, femur and sternum and has demonstrated a high efficacy for pain relief and functional improvement [6,13,16,20,24,25,27,28]. Percutaneous injection of cement can stabilize and strengthen bones in the body, which has been postulated as the major mechanism of pain relief [7,15].…”

Section: Discussionmentioning

confidence: 99%

“…1. The pretreatment dosimetric plan of delivery of a single 8 Gy dose to the surgical cavity pathological vertebral fractures such as percutaneous osteoplasty, kyphoplasty, and vertebraplasty [6,9,13,16,20,24,25,27]. Since the first report of percutaneous vertebralplasty appeared in 1987 [9], such techniques gained wide application in the treatment of osteoporotic compression, osteolytic metastases, and hemangioma of vertebrae.…”

Section: Discussionmentioning

confidence: 99%

A Single-Dose Conformal Delivery of Radiotherapy following Osteoplasty

Wernicke

Sabbas

Kulidzhanov

et al. 2012

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Multiple myeloma (MM) is a very radiosensitive tumor. Fractionated external beam radiation, which takes approximately 2 weeks of therapy, is typically used to irradiate myelomatous bone lesions with the goal of palliation. However, traditional radiotherapeutic techniques are not only lengthy but they also involve a considerable amount of healthy bone marrow in the treatment ports, which may undermine the total marrow reserve of a patient. Because of the limited survival time of patients with metastatic cancer, novel treatment concepts shortening the overall treatment time is desirable. We present an innovative approach of delivering targeted intra-operative radiotherapy to a solitary osteolytic metastasis in one application, while sparing healthy bone marrow from radiation toxicity and substantially reducing the overall treatment time. A 78-year-old Caucasian male with MM, previously treated with chemotherapy, who was off chemotherapy for 2 years due to bone marrow suppression, presented with a solitary recurrence at the left anterior superior iliac spine of the left iliac wing as diagnosed by PET-CT scan. This lesion was treated with a minimally invasive osteoplasty and intra-operative brachytherapy with to a dose of 8 Gy delivered to the surgical cavity only, followed by injection of the bone cement into the cavity. Three months after the procedure, the area of treatment demonstrated no uptake on a follow-up PET-CT scan. At 1.5 years after this procedure, 100% local control continues to persist in the treated area, as evidenced on nuclear imaging. To our knowledge, this is the first case of using focal intraoperative brachytherapy confined to the area of the pelvis in a patient treated for a solitary metastasis from MM. The purpose of the article is to present a novel approach as a more convenient and focal treatment of bony lesions of MM.

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“…Methyl methacrylate injection of weightbearing parts of the acetabulum may also allow improvement in walking. [44][45][46][47][48][49] The decision to carry out this procedure should be made by a multidiscipinary team including interventional radiologists, orthopaedic surgeons, oncologists and radiotherapists. At least, CT should be performed before the procedure to assess the exact location and extent of the lesion and the presence of cortical destruction or fracture.…”

Section: -43mentioning

confidence: 99%

Interventional MSK procedures: the hip

Dodré¹,

Lefebvre²,

Cockenpot³

et al. 2016

BJR

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Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures. INTRODUCTIONHip intra-articular injections have been used for many years as a diagnostic and/or therapeutic tool and even today remain an effective treatment for osteoarthritis providing pain relief. Ultrasound guidance can be used for injections in patients with greater trochanteric pain syndrome and CT scan guidance for corticosteroid injection in the management of anterior iliopsoas impingement after total hip arthroplasty. Interventional radiology plays a major role in the management of bone tumours. Several image-guided percutaneous ablation methods have proved effective for palliation of metastases involving bone and for the treatment of benign bone tumours, namely osteoid osteoma. To treat pain and consolidate the bone, cementoplasty could be required. In the therapeutic management of acetabular fractures, the combination of CT and fluoroscopy guidance could have a place in treating non-displaced or minimally displaced acetabular roof fractures.

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Pelvic Osteoplasty in Osteolytic Metastases: Technical Approach under Fluoroscopic Guidance and Early Clinical Results

Cited by 98 publications

References 12 publications

Percutaneous Cement Augmentations of Malignant Lesions of the Sacrum and Pelvis: Fig 1.

Percutaneous Cement Augmentations of Malignant Lesions of the Sacrum and Pelvis: Fig 1.

A Single-Dose Conformal Delivery of Radiotherapy following Osteoplasty

Interventional MSK procedures: the hip

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