Selective intra-arterial chemoembolization of pelvic and spine bone metastases

Abstract

The purpose of this study was to determine the effect of interventional palliative therapy by using chemoembolization on metastatic bone pain and tumor bulk in inoperable metastases where chemotherapy and radiotherapy had failed. Twenty-five patients (mean age: 59 years) underwent chemoembolization of symptomatic lytic lesions involving the spinal column (n=10), iliac bone and sacrum (n=15). The study design consisted of at least three procedures based on combined chemoembolization performed under analog-sedation. Therapeutic agents were carboplatin for selective chemotherapy and pirarubicin mixed with polyvinyl alcohol foam for chemoembolization. Fifteen of 18 (83%) patients had significant pain relief, as shown by the decrease of analgesic drug use. Mean clinical response duration was 12 months. Radiologically, ten patients were stable. A partial response was observed in four patients, while a complete response was seen in two others. Selective intra-arterial chemoembolization gives longer pain relief than embolization, compared to the literature data, probably because of partial response with local anti-cancer drugs.

Radiologie interventionnelle des métastases osseuses

“…Sur cette base, certains auteurs, encouragés par le succès de l'embolisation, ont développé des techniques de perfusion intra-artérielle d'antimitotiques ou de chimioembolisation qui associent chimiothérapie intra-artérielle et embolisation hypersélective [31].…”

“…Quoi qu'il en soit, une réponse partielle ou complète est observée dans 50 à 70 % des cas, et cette méthode s'avère souvent efficace dans la prise en charge des métastases pré-valentes non accessibles aux autres traitements locaux [31].…”

2012 European Thyroid Association Guidelines for Metastatic Medullary Thyroid Cancer

“…Some patients present with painful bone lesions, fracture, or spinal cord compression. Experience with bone metastases from tumors other than MTC have demonstrated that percutaneous methods of treatment such as cementoplasty (image-guided injection of polymethyl metacrylate cement in bones), thermal ablation (radiofrequency or cryotherapy) and arterial embolization followed by surgery, or a combination of these methods, have been associated with pain reduction and bone consolidation[25,26,27,28,29,30,31,32]. Isolated bone metastases may be surgically resected or treated with percutaneous methods, but it is extremely uncommon for these patients to be rendered free of disease.…”

Spinal intraarterial chemotherapy: interim results of a Phase I clinical trial

“…Chiras et al described a series of 25 patients with metastatic disease to the spinal column (n = 10), iliac bone and sacrum (n = 15) who were treated with transarterial chemoembolization using polyvinyl alcohol particles, pirarubicin, and carboplatin, achieving significant pain relief in 15 patients and local tumor control in 16 patients with available imaging follow-up. 6 There are two main differences between this protocol and ours: 1) our technique does not involve the use of embolic agents and consists of chemotherapy infusion only; and 2) the focus of our treatment is the epidural disease and neurological symptoms as opposed to pain levels and overall tumor size.…”

“…Similarly to our approach, Chiras et al used a single therapeutic agent for treating bone metastatic disease caused by a variety of tumors. 6 Ideally, each tumor could have been targeted with a separate chemotherapy agent, but this approach requires separate protocols, investigational new drug approvals, and trials for each drug. Given the low rate of accrual and the strict indications, it would take many years before such trials would be completed.…”