Abstract
Purpose
This study was done to evaluate embolisation for palliative and/or adjuvant treatment of bone metastases from renal cell carcinoma and discuss the clinical and imaging results.
Materials and methods
We retrospectively studied 107 patients with bone metastases from renal cell carcinoma treated from December 2002 to January 2011 with 163 embolisations using N-2-butyl cyanoacrylate (NBCA). Mean tumour diameter before embolisation was 8.8 cm and mean follow-up 4 years. Clinical and imaging effects of treatment were evaluated at follow-up examinations with a pain score scale, analgesic use, hypoattenuating areas, tumour size and ossification.
Results
A clinical response was achieved in 157 (96%) and no response in six embolisations of sacroiliac metastases. Mean duration of clinical response was 10 (range 1–12) months. Hypoattenuating areas resembling tumour necrosis were observed in all patients. Variable ossification appeared in 41 patients. Mean maximal tumour diameter after embolisation was 4.0 cm. One patient had intraprocedural tear of the left L3 artery and iliopsoas haemorrhage and was treated with occlusion of the bleeding vessel with NBCA. All patients had variable ischaemic pain that recovered completely within 2–4 days. Postembolisation syndrome was diagnosed after 15 embolisations (9.2%). Transient paraesthesias in the lower extremities were observed after 25 embolisations (25%) of pelvis and sacrum metastatic lesions.
Conclusions
Embolisation with NBCA is recommended as primary or palliative treatment of bone metastases from renal cell carcinoma. Strict adherence to the principles of transcatheter embolisation is important to avoid complications.
Riassunto
Obiettivo
Scopo del presente lavoro è stato valutare l’embolizzazione come trattamento palliativo e/o adiuvante delle metastasi ossee da carcinoma a cellule renali e discuterne i risultati clinici e radiologici.
Materiali e metodi
Abbiamo studiato retrospettivamente 107 pazienti con metastasi da carcinoma renale trattati con 163 embolizzazioni con N-2-butil ciano-acrilato (NBCA) da dicembre 2002 a gennaio 2011. Il diametro medio tumorale prima dell’embolizzazione era di 8,8 cm. La media dei follow-up era di di 4 anni. Gli effetti clinici e radiologici sono stati valutati durante i successivi controlli con una scala di punteggio per il dolore, uso degli analgesici, aree di ipoattenuazione, dimensione del tumore ed ossificazione.
Risultati
Una risposta clinica è stata ottenuta in 157 embolizzazioni (96%) mentre non è stata ottenuta alcuna risposta in 6 embolizzazioni di metastasi alla sacro-iliaca. La durata media della risposta clinica è stata di 10 mesi (da 1 a 12 mesi). Aree di ipoattenuazione associabili a necrosi tumorale sono state osservate in tutti i pazienti. Ossificazione variabile è stata osservata in 41 pazienti. La media dei diametri tumorali dopo l’embolizzazione è stata di 4,0 cm. Un paziente ha riportato, durante la procedura, una lesione dell’arteria sinistra di L3 ed emorragia nell’ileo-psoas, è stato trattato con occlusione del vaso sanguinante con NBCA. Tutti i pazienti hanno avuto un grado variabile di dolore ischemico che è completamente scomparso in un arco di 2–4 giorni. Dopo la procedura sono stati diagnosticati 15 casi (9,2%) di sindrome post-embolizzazione. Parestesie transitorie agli arti inferiori sono state osservate dopo 25 embolizzazioni (25%) di lesioni metastatiche al sacro ed alle pelvi.
Conclusioni
L’embolizzazione con NBCA è raccomandata come trattamento sia primario che palliativo delle metastasi ossee da carcinoma renale. Una rigorosa aderenza ai principi di embolizzazione attraverso catetere è importante per evitare complicazioni.
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References/Bibliografia
Sun S, Lang EV (1998) Bone metastases from renal cell carcinoma: preoperative embolization. J Vasc Interv Radiol 9:263–269
Chatziioannou AN, Johnson ME, Pneumaticos SG et al (2000) Preoperative embolization of bone metastases from renal cell carcinoma. Eur Radiol 10:593–596
Forauer AR, Kent E, Cwikiel WH et al (2007) Selective palliative transcatheter embolization of bony metastases from renal cell carcinoma. Acta Oncologica 46:1012–1018
Barton PP, Waneck RE, Karnel FJ et al (1996) Embolization of bone metastases. J Vasc Interv Radiol 7:81–88
Rehák S, Krajina A, Ungermann L et al (2008) The role of embolization in radical surgery of renal cell carcinoma spinal metastases. Acta Neurochir (Wien) 150:1177–1181
Yilmaz S, Sindel T, Lüleci E (2002) Repeated palliative embolization of renal cell carcinoma metastases. Clin Radiol 57:319–320
Miller DL, Haines GA, Juliano PJ, Ghosh BC (1995) Preoperative embolization of osseous metastases from hypervascular cancers. J Surg Oncol 60:133–134
Roscoe MW, McBroom RJ, St Louis E et al (1989) Preoperative embolization in the treatment of osseous metastases from renal cell carcinoma. Clin Orthop Relat Res 238:302–307
Varma J, Huben RP, Wajsman Z, Pontes JE (1984) Therapeutic embolization of pelvic metastases of renal cell carcinoma. J Urol 131:647–649
Rowe DM, Becker GJ, Rabe FE et al (1984) Osseous metastases from renal cell carcinoma: embolization and surgery for restoration of function. Work in progress. Radiology 150:673–676
Braedel HU, Zwergel U, Knopp W (1984) Embolization of pelvic bone metastases from renal cell carcinoma. Eur Urol 10:380–384
Coleman RE (2001) Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treatment Reviews 27:165–176
Shipman CM, Rogers MJ, Apperley JF et al (1997) Bisphosphonates induce apoptosis in human myeloma cell lines: a novel anti-tumour activity. Br J Haematol 98:665–672
Hartsell WF, Scott CB, Bruner DW et al (2005) Randomized trial of short-versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 97:798–804
Tomita K, Kawahara N, Kobayashi T et al (2001) Surgical strategy for spinal metastases. Spine 26:298–306
Muresan MM, Olivier P, Leclère J et al (2008) Bone metastases from differentiated thyroid carcinoma. Endocrine-Related Cancer 15:37–49
Wirbel RJ, Roth R, Schulte M et al (2005) Preoperative embolization in spinal and pelvic metastases. J Orthop Sci 10:253–257
Hess T, Kramann B, Schmidt E, Rupp S (1997) Use of pre-operative vascular embolization in spinal metastasis resection. Arch Orthop Trauma Surg 116:279–282
Layalle I, Flandroy P, Trotteur G, Dondelinger RF (1998) Arterial embolization of bone metastases: is it worthwhile? J Belge Radiol 81:223–225
Chuang VP, Wallace S, Swanson D et al (1979) Arterial occlusion in the management of pain from metastatic renal carcinoma. Radiology 133:611–614
Almgard LE, Fernstrom I, Haverling M, Ljungqvist A (1973) Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br J Urol 45:474–479
Bowers TA, Murray JA, Charnsangavej C et al (1982) Bone metastases from renal carcinoma: the preoperative use of transcatheter arterial occlusion. J Bone Joint Surg 64:749–754
Christensen K, Dyreborg U, Andersen JF, Nissem HM (1985) The value of transvascular embolization in the treatment of renal carcinoma. J Urol 133:191–193
Weber J (1982) Palliative embolization in bone metastasis of hypernephroma using oily contrast-labeled gel. Ann Radiol 25:460–462
Katz J, Melzack R (1999) Measurement of pain. Surg Clin North Am 79:231–252
Kickuth R, Waldherr C, Hoppe H et al (2008) Interventional management of hypervascular osseous metastasis: role of embolotherapy before orthopedic tumor resection and bone stabilization. AJR Am J Roentgenol 191:W240–W247
Manke C, Bretschneider T, Lenhart M et al (2001) Spinal metastases from renal cell carcinoma: effect of preoperative particle embolization on intraoperative blood loss. AJNR Am J Neuroradiol 22:997–1003
Rockwell S (1997) Oxygen delivery: implications for the biology and therapy of solid tumors. Oncol Res 9:383–390
Rossi G, Mavrogenis AF, Rimondi E et al (2011) Selective embolization with N-butyl cyanoacrylate for metastatic bone disease. J Vasc Interv Radiol 22:462–470
Breslau J, Eskridge JM (1995) Preoperative embolization of spinal tumors. J Vasc Interv Radiol 6:871–875
Hemingway AP, Allison DJ (1988) Complications of embolization: analysis of 410 procedures. Radiology 166:669–672
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Rossi, G., Mavrogenis, A.F., Casadei, R. et al. Embolisation of bone metastases from renal cancer. Radiol med 118, 291–302 (2013). https://doi.org/10.1007/s11547-012-0802-4
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DOI: https://doi.org/10.1007/s11547-012-0802-4