Skip to main content

Advertisement

SpringerLink
Log in

Palliative Percutaneous Cryoablation and Cementoplasty of Acetabular Metastases: Factors Affecting Pain Control and Fracture Risk

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To characterize the response of patients with acetabular metastases following combined cryoablation and cementoplasty (CCC) for pain palliation and fracture risk reduction, based on completeness of ablation and the presence of pre-existing pathologic fracture.

Materials and Methods

Thirty-nine consecutive acetabular CCC procedures were performed in 37 patients (24 M:13F, age 66 ± 8 years). Pain was assessed using a 0–10 numeric rating scale. Development of new or progression of pre-existing fractures and local tumor progression (LTP) were determined on follow-up imaging. Pain score reduction and fracture development rates were compared by ablation completeness and the presence of pre-existing fractures.

Results

Twenty-three of 27 (85%) patients with evaluable pain scores had reduced pain, decreasing from 7.5 ± 2.1 to 3.6 ± 2.6 (p < 0.0001). Of 39 tumors, 28 (72%) were completely ablated with no significant difference in pain reduction after complete versus incomplete ablations (p = 0.9387). Six of 30 (20%) patients with follow-up imaging demonstrated new/progressive acetabular fractures. Four of 5 (80%) patients with LTP developed new/progressive fractures compared to 2 of 25 (8%) without tumor progression (p = 0.0003). Pre-existing fracture was not associated with subsequent fracture/fracture progression (p = 0.2986). However, patients with prior acetabular radiation therapy or surgery had increased fractures following treatment (p = 0.0380).

Conclusion

Complete acetabular tumor ablation during CCC was not associated with superior pain relief compared to subtotal ablation but did result in improved fracture stabilization. Pre-treatment pathologic fractures were not associated with fracture progression, but new/progressive fractures were more frequent in patients with prior radiation therapy or surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hernandez RK, Adhia A, Wade SW, et al. Prevalence of bone metastases and bone-targeting agent use among solid tumor patients in the United States. Clin Epidemiol. 2015;7:335–45.

    PubMed  PubMed Central  Google Scholar 

  2. Dorrepaal KL, Aaronson NK, van Dam FSAM. Pain experience and pain management among hospitalized cancer patients. Cancer. 1989;63:593–8.

    Article  CAS  Google Scholar 

  3. Janjan N, Lutz ST, Bedwinek JM, et al. Therapeutic guidelines for the treatment of bone metastasis: a report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology. J Palliat Med. 2009;12:417–26.

    Article  Google Scholar 

  4. Callstrom MR, Dupuy DE, Solomon SB, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 2013;119:1033–41.

    Article  Google Scholar 

  5. Goetz MP, Callstrom MR, Charboneau JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 2004;22:300–6.

    Article  Google Scholar 

  6. Pusceddu C, Sotgia B, Fele RM, Melis L. Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 2013;24:229–33.

    Article  Google Scholar 

  7. Dupuy DE, Liu D, Hartfeil D, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116:989–97.

    Article  Google Scholar 

  8. Anselmetti GC, Manca A, Ortega C, Grignani G, Debernardi F, Regge D. Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Intervent Radiol. 2008;31:1165–73.

    Article  Google Scholar 

  9. Kelekis A, Lovblad KO, Mehdizade A, et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J. Vasc Int Radiol JVIR. 2005;16:81–8.

    Article  Google Scholar 

  10. Lane MD, Le HB, Lee S, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skeletal Radiol. 2011;40:25–32.

    Article  Google Scholar 

  11. Prologo JD, Passalacqua M, Patel I, Bohnert N, Corn DJ. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience. Skeletal Radiol. 2014;43:1551–9.

    Article  Google Scholar 

  12. Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol. 2016;39:74–80.

    Article  Google Scholar 

  13. Wallace AN, Huang AJ, Vaswani D, Chang RO, Jennings JW. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note. Skeletal Radiol. 2016;45:401–5.

    Article  Google Scholar 

  14. Friedman MV, Hillen TJ, Wessell DE, Hildebolt CF, Jennings JW. Hip chondrolysis and femoral head osteonecrosis: a complication of periacetabular cryoablation. J Vasc Interv Radiol. 2014;25:1580–8.

    Article  Google Scholar 

  15. Kurup AN, Schmit GD, Morris JM, et al. Avoiding complications in bone and soft tissue ablation. Cardiovasc Intervent Radiol. 2017;40:166–76.

    Article  Google Scholar 

  16. Prologo JD, Patel I, Buethe J, Bohnert N. Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol. 2014;25(769–75):e2.

    Google Scholar 

  17. Mantyh PW. Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care. 2014;8:83–90.

    Article  Google Scholar 

  18. Kurup AN, Morris JM, Schmit GD, et al. Balloon-assisted osteoplasty of periacetabular tumors following percutaneous cryoablation. J Vasc Interv Radiol. 2015;26:588–94.

    Article  Google Scholar 

  19. Castaneda Rodriguez WR, Callstrom MR. Effective pain palliation and prevention of fracture for axial-loading skeletal metastases using combined cryoablation and cementoplasty. Tech Vasc Interv Radiol. 2011;14:160–9.

    Article  Google Scholar 

  20. Kurup AN, Morris JM, Boon AJ, et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol. 2014;25:1657–64.

    Article  Google Scholar 

  21. Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria-A 10-Year Update. Radiology. 2014;273:241–60.

    Article  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  23. Campbell I. Chi squared and Fisher–Irwin tests of two-by-two tables with small sample recommendations. Stat Med. 2007;26:3661–75.

    Article  Google Scholar 

  24. Richardson JT. The analysis of 2 × 2 contingency tables–yet again. Stat Med. 2011;30:890 (author reply 1–2).

    Article  Google Scholar 

  25. Callstrom MR, Charboneau JW, Goetz MP, et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skeletal Radiol. 2006;35:1–15.

    Article  Google Scholar 

  26. Coupal TM, Pennycooke K, Mallinson PI, et al. The hopeless case? Palliative cryoablation and cementoplasty procedures for palliation of large pelvic bone metastases. Pain Physician. 2017;20:E1053–61.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology (ANK, GDS, TDA, MRC), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA

    A. Nicholas Kurup, Grant D. Schmit, Thomas D. Atwell & Matthew R. Callstrom

  2. Department of Orthopedic Surgery (PRS), Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA

    Peter S. Rose

  3. Department of Radiology (EBS), Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI, 54703, USA

    Erik B. Sviggum

  4. Department of Radiology (WRC), Park Nicollet, 6500 Excelsior Blvd., St. Louis Park, MN, 55426, USA

    Wilfrido R. Castaneda

Authors
  1. A. Nicholas Kurup
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Grant D. Schmit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas D. Atwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erik B. Sviggum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilfrido R. Castaneda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter S. Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthew R. Callstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Nicholas Kurup.

Ethics declarations

Conflict of interest

ANK and MRC receive royalties from UpToDate, Inc. and have received research support from Galil Medical. MRC also has received research grants from General Electric Medical Systems, Thermedical, and Siemens Medical. MRC is a paid consultant for Covidien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kurup, A.N., Schmit, G.D., Atwell, T.D. et al. Palliative Percutaneous Cryoablation and Cementoplasty of Acetabular Metastases: Factors Affecting Pain Control and Fracture Risk. Cardiovasc Intervent Radiol 41, 1735–1742 (2018). https://doi.org/10.1007/s00270-018-1998-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-018-1998-9

Keywords

Search

Navigation