Injections of bone cement to support weakened bones in patients with metastatic bone disease provide immediate and substantial pain relief for patients who can often then leave their wheelchairs behind and walk out of the medical centre, a researcher reported here at the Society of Interventional Radiology (SIR) 34th Annual Scientific Meeting.
In a presentation on March 9, investigator Giovanni Carlo Anselmetti, MD, Institute for Cancer Research and Treatment, Candiolo, Italy, said this percutaneous osteoplasty offers an option to patients who have run out of standard treatments.
“For patients who have not responded to conventional therapy and for whom surgery is not feasible, this is huge,” he said. “It has the ‘Lazarus effect’ in that the patient could walk out of the hospital again without pain.”
To assess the safety and effectiveness of the procedure, 81 consecutive patients with extraspinal lytic lesions due both to benign or metastatic diseases underwent injection of polymethyl-methacrylate (PMMA) through a bevelled 13-gauge vertebroplasty needle. Five patients underwent a second procedure for the occurrence of a new lesion and 1 for the relapse of symptoms.
Of the 81 patients, 74 had malignancies; 71 had lytic metastases and 3 multiple myeloma; 7 patients had benign diseases such as rheumatoid arthritis. Treated bones were proximal femur, sacrum and pelvic bones, the foot, metacarpal bone, ribs, scapulae, and humeral head. It is not possible to treat the long bones with PMMA.
All procedures were performed under fluoroscopic guidance in combination with computed tomography under local anaesthesia or deep sedation.
No deaths or major complications occurred during the procedure. Pain was evaluated on the 11-point visual analogue scale (VAS) before and after each procedure, within 24 hours, and during a follow-up up to 36 months.
Mean VAS pain score decreased from 8.8 to 1.8 within the first 24 hours. Mean VAS difference was 7.0 (P < .0001 Wilcoxon signed-rank test).
A total of 64 patients (79%) suspended narcotic drugs; 43 patients (53%) suspended analgesic therapy. Five patients (6.1%) had no improvement in pain.
Average follow-up was 11.2 months (3-36 months). No significant difference in terms of pain relief (P = .81) was found in follow-up subgroups.
The osteoplasty procedure, for the most part, is not curative, but rather palliative by reducing pain, preventing additional bone destruction and improving function of the patient, according to the researchers.
Dr. Anselmetti said: “Painful bone [metastases] affect the quality of life in about one-third of patients with cancer. I cannot emphasise enough how important it is to provide relief to patients who are dying from cancer. This technique is very simple and provides pain relief within 24 hours. It’s easier for the oncologist to treat the patient, too, if they are not on narcotics.”
“It’s just a matter of getting the message out that this is available,” he added.
[Presentation title: Percutaneous Osteoplasty Performed in Painful Extraspinal Osteolytic Lesions – Personal Experience in 81 Patients Treated for Benign Diseases and Metastases. Abstract 36]
Source: Doctors Guide Publishing Limited
published: March 11, 2009 in: Healthcare, News, Orthopaedics, Products