Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR)

Abstract

Interventional radiology provides local management of bone metastases (BM) with a palliative intent in most cases, or with a curative intent in selected patients. Its role has rapidly expanded in the last decade, offering new treatment solutions often in combination with surgery, radiation therapy and medical treatments. The aim of the present paper is to increase awareness, acceptance and adoption of interventional radiology procedures for the treatment of BM; and to present the joint position of the Italian College of Musculoskeletal Radiology and the Italian College of Interventional Radiology.

Pre-Operative Trans-Arterial Embolization of a Hypervascular Bone Metastasis

“…Liquid agents, often combined with embolisation coils or plugs, are applied in the presence of arterio-venous shunting. Particles are mainly used for bone devascularisation [1].…”

French Multidisciplinary Approach for the Treatment of MSK Tumors

“…SREs are the most common indication for referral to the MDTB. 2,4 A few other cohorts of patients may be referred to get the best therapy with the best local tumor control; generally, these patients are those presenting with (1) an oligometastatic status (i.e., fewer than three metastases regardless of the metastatic site, size < 2-3 cm); (2) an oligo-progressive metastatic disease (i.e., patients with one or few bone metastases evolving under systemic therapies despite an overall stable and controlled systemic multimetastatic disease); or (3) an impending complication that may complicate untreated bone metastasis (e.g., metastasis of the posterior third of the vertebral body that may result in a spinal cord compression). 2,69,70 The armamentarium of local treatments include surgery, radiation therapy, and interventional techniques (i.e., ablation, embolization, osteoplasty, and osteosynthesis).…”

“…Osteoplasty and osteosynthesis are applied according to standard and relatively simple biomechanics. 4,91 In general, osteoplasty is highly resistant to compressive stresses, and it is therefore applied in vertebral bodies, sacral wings, acetabula, and to fill small lytic lesions of the epiphyseal area in long bones. 4 In contrast, osteosynthesis is applied to treat non-or Fig.…”

“…4,91 In general, osteoplasty is highly resistant to compressive stresses, and it is therefore applied in vertebral bodies, sacral wings, acetabula, and to fill small lytic lesions of the epiphyseal area in long bones. 4 In contrast, osteosynthesis is applied to treat non-or Fig. 4 (a) 53-year-old female patient with a single renal cell carcinoma bone metastasis at T11, which due to her expected long life expectancy, was referred for surgery and corpectomy of this level.…”

“…minimally displaced fractures of the pelvic ring or of the femoral neck, provided there is no involvement of the trochanteric region or large cortical lysis. 4 Percutaneous osteoplasty and osteosynthesis may also be provided as stand-alone palliative treatments without being coupled to ablation to achieve effective management of pathologic bone insufficiency and impending fractures [92][93][94][95][96][97] in multi-metastatic patients or in those with contraindications to surgery (►Figs. [6][7][8].…”