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. 2023 Jul-Aug;37(4):1816-1821.
doi: 10.21873/invivo.13272.

Clinical Utility of Bland Embolization Using Microspheres for Painful Malignant Musculoskeletal Tumors

Junichi Taniguchi  1 , Haruyuki Takaki  2 , Hiroshi Kodama  2 , Takayuki Kawaguchi  3 , Motonori Takahagi  2 , Atsushi Ogasawara  2 , Yasukazu Kako  2 , Kaoru Kobayashi  2 , Tetsuya Minami  4 , Hiroyuki Futani  3 , Koichiro Yamakado  2
Affiliations

Clinical Utility of Bland Embolization Using Microspheres for Painful Malignant Musculoskeletal Tumors

Junichi Taniguchi et al. In Vivo. 2023 Jul-Aug.

Abstract

Background/aim: To evaluate retrospectively whether bland embolization using microspheres is safe and useful for relieving pain in patients with painful malignant musculoskeletal (MSK) tumors.

Patients and methods: Bland embolization using microspheres was performed for 20 patients (11 women/9 men) with a median age of 69 years (range=40-89 years) who had 22 painful malignant MSK tumors. The maximum tumor diameters were 2.4-13.8 cm (median, 7.5 cm). Pain was evaluated using the visual analog scale. A decrease of this score by 2 or more after embolization was defined as clinically effective pain relief. Adverse events (AEs) were evaluated using CTCAE v5.0. Objective response, disease control rates, and overall survival were also evaluated.

Results: Effective pain relief was achieved in 18 patients (90.0%, 18/20). Grade-3 AEs developed in four patients (20.0%, 4/20): skin ulcer (n=2), skin ulcer and pain (n=1), and muscle weakness with dysesthesia (n=1). No grade-4 or grade-5 AEs developed. Objective response and disease control rates were 26.7% (4/15) and 86.7% (13/15), respectively. The 1-year survival rate was 43.8%, with median survival of 9.2 months (range=0.5-41.0 months).

Conclusion: Although the survival benefit is equivocal, bland embolization is acceptably safe and useful for relieving pain by controlling tumor growth in patients with painful malignant MSK tumors.

Keywords: Bland embolization using microspheres; effective pain relief; painful malignant musculoskeletal (MSK) tumors.

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Conflict of interest statement

The Authors declare that they have no conflicts of interest in relation to this study.

Figures

Figure 1
Figure 1. Flowchart of this study.
Figure 2
Figure 2. A woman in her 70s with a painful metastasis from uterine leiomyosarcoma in the left thigh. A) Angiography showed a hypervascular tumor in her left thigh. B) Angiography immediately after embolization showed the disappearance of tumor enhancement. C) Contrast-enhanced magnetic resonance (MR) imaging showed an enhanced tumor measuring 10.4 cm in her left thigh before embolization. D) Contrast-enhanced computed tomography at 1 month after embolization demonstrated the complete disappearance of tumor enhancement. E) Contrast-enhanced MR imaging at 18 months after embolization demonstrated tumor shrinkage.
Figure 3
Figure 3. Changes in VAS scores before and a day, 1-2 weeks, and 3-4 weeks after embolization. After embolization, median VAS scores decreased significantly from 7.0 (range=3.0-9.0) to 4.0 (range=0-9.0) (p<0.001) at 1-2 weeks and to 2.0 (range=0-8.0) (p=0.001) at 3-4 weeks. However, median VAS scores had not decreased significantly from 7.0 (range=3.0-9.0) to 5.5 (range=1.0-10.0) (p=0.23) a day later.
Figure 4
Figure 4. Cumulative overall survival rates were 44% [95% confidence interval (CI)=21-65%] at 1 year and 15% (95%CI=1-45%) at three years, with a median survival time of 9.2 months (range=0.5-41.0 months).
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