Hong Kong Med J 2013;19:317–22 | Number 4, August 2013 | Epub 3 Apr 2013
DOI: 10.12809/hkmj133743
Percutaneous cementoplasty of osteolytic metastases induces immediate and long-lasting pain relief in oncological patients
OC Leung, WL Poon, SF Nyaw, SH Luk
Department of Diagnostic Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
OBJECTIVE. To evaluate the clinical efficacy of percutaneous cementoplasty with respect to pain relief in patients with refractory painful bone metastases.
DESIGN. Case series.
SETTING. Regional hospital, Hong Kong.
PATIENTS. All oncological patients with painful bone metastases despite conventional treatment seen between October 2006 and May 2010 were recruited.
INTERVENTIONS. Cementoplasty with or without radiofrequency ablation.
MAIN OUTCOME MEASURES. Pain score before and after the procedure.
RESULTS. In all, 12 patients with 13 lesions received cementoplasty. Two patients were excluded from the analysis because of inadequate documentation of pain score due to rapid disease progression. For the remaining 10 patients with 11 metastases, the primary sites were the lung (n=3), renal cell carcinoma (n=2), rectum (n=2), pancreas (n=1), multiple myeloma (n=1), and soft tissue sarcoma (n=1). The locations of the metastatic lesions were scapula (n=1), thoracic vertebrae (n=1), lumbar vertebrae (n=3), and pelvic bones (n=6). Eight lesions were treated by cementoplasty alone, whereas the other three associated with large soft tissue components had radiofrequency ablation followed by cementoplasty in a single setting. Immediate or near-immediate pain relief after treatment was achieved in 10 out of 11 lesions; the median pain score was 5 before treatment and decreased to 2 a week after treatment (P=0.039). In all lesions for which the pain was successfully controlled in the first week, the palliation effect persisted at subsequent follow-ups. The median follow-up period for these patients was 16 weeks, and the longest pain-relieving effect was at least 9 months.
CONCLUSION. In our experience, cementoplasty with or without radiofrequency ablation achieves satisfactory and long-lasting pain control in oncological patients with bone metastases. This is the first local study to describe the effect of cementoplasty for pain relief. Patients with painful bone metastases that are refractory to conventional treatments can benefit from cementoplasty, which should therefore be considered when conservative treatments fail.
Key words: Bone neoplasms; Cementoplasty; Pain management
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