Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review

Abstract

Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients' quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.

Keywords: ablation techniques; bone metastases; embolization; high-intensity focused ultrasound ablation; imaging; interventional radiology.

Figure 1

(A) Axial CT scan of the pelvis of a 63-year-old man with a painful left acetabular bone metastasis from kidney cancer (arrowheads). (B) Arteriography shows pathological vascularization originating from branches of the internal iliac artery. (C) After arterial embolization, arteriography demonstrates complete occlusion of the feeding vessels. (D) Axial CT scan performed 12 months after treatment shows signs of re-ossification and local disease control (arrowhead).

Figure 2

(A) PET/CT scan of a 56-year-old woman, which shows an intense uptake of 18F-FDG in correspondence with a painful vertebral metastasis from breast cancer in the body of T7 (arrowhead). (B) Radiofrequency ablation of the lesion performed through a transcostovertebral approach.

Figure 3

(A) Axial CT scan of a 54-year-old woman with a sacral metastasis from endometrial sarcoma treated with cryoablation for palliative intent. The ice ball is visible as a hypodense circle surrounding the tip of the needle (arrowheads). (B) 18F-FDG PET/CT scan performed 3 months after the procedure demonstrates the absence of pathologic radiotracer uptake in the ablated area (arrowhead).