New data on osteoplasty for bone metastases

HealthDay is reporting on data presented today by an Italian research group at the Society of Interventional Radiology annual meeting in San Diego. According to the HealthDay report, injecting “bone cement” into lesions in patients whose cancer has spread to their bones (“osteoplasty”) can help such patients to live the remainder of their lives relatively pain-free.

Dr. Giovanni Carlo Anselmetti, of the Institute for Cancer Research and Treatment in Turin, is quoted as saying: “The majority of … patients experienced significant or complete and long-lasting pain relief after osteoplasty, with immediate improvement of clinical conditions and quality of life.”

There was no reference in the available study to treatment of bone metastases caused specifically by prostate cancer. However, Dr. Anselmetti described the case of a 79-year-old nun who was confined to her bed because of thyroid cancer that had spread to her pelvis who stood and walked just two hours after the minimally invasive procedure. We assume that this type of procedure is potentially appropriate for at least some prostate cancer patients with advancing bone disease.

Osteoplaty is a palliative procedure. “It’s not going to be a curative procedure, but we’ve seen dramatic improvements in pain control,” said Dr. Mark Montgomery, an associate professor of radiology at Texas A&M Health Science Center College of Medicine and director of interventional radiology and vice chair of education in radiology at Scott & White.

The use of osteoplasty is usually preceded by radiofrequency ablation (extreme heat) or cryoablation (freezing) to kill nerve cells near the tumor. The orthopedist then injects a form of  bone cement into the bone lesion with the help of image guidance. In the study reported by Dr. Anselmetti, they used polymethylmethacrylate or PMMA as the form of bone cement. Their study involved 81 patients, aged between 36 and 94 years, and mostly female, who underwent osteoplasty at least once. Seventy-four of the participants had cancer, while a handful had “benign” diseases such as rheumatoid arthritis.

Bones such as the pelvis, femur, sacrum, ribs, and knee were treated, as well as other bone structures. The patients’ mean pain score dropped significantly within 24 hours of the procedure.A total of 64/81 patients (79 percent) were able to discontinue use of narcotics and 43/81 (53 percent) also stopped using any other pain medications. Only five of the patients showed no improvement in pain. There were no deaths or major complications.

“There’s a lack of an awareness of some of the options for patients that have painful bone metastases,” Montgomery added. “It’s physician education as much as it is patient education.”

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