Combination treatment of vertebral and paravertebral metastatic tumors by transarterial chemoembolization and percutaneous vertebroplasty

Abstract

To evaluate the efficacy and safety of combining transarterial chemoembolization and percutaneous vertebroplasty (PVP) in the treatment of vertebral and paravertebral metastatic tumors. A retrospective review was conducted in 49 patients with severer painful tumor metastasis in 72 vertebrae and paravertebral tissue who had failed noninvasive treatment at our institution from March 2003 to December 2009. Among them, there were intractable radicular pain (n = 17) and slight or no motor and sensory function (n = 6). All patients under transarterial chemoembolization were followed within 6 days by PVP. Computed tomography (CT) was performed within 3 days after PVP to observe the distribution of PMMA (para-methoxymethamphetamine)in vertebrae and whether or not there was any leakage. The efficacy was assessed by the change of pain level after combined treatment. Bilateral vertebral arteries were selected in 44 cases with 65 vertebrae. And only unilateral vertebral artery was selected in 5 cases with 7 vertebrae. Except for 2 vertebrae with simple artery infusion, 29 vertebrae were embolized by 1 - 2 ml of lipiodolization and gelfoam particles and 41 vertebrae by gelatine particles. And an average volume of 4.23 ml and 5.39 ml was injected in each thoracic and lumbar vertebra respectively. The rate of efficacy was at 87.8% within 3 months after combined therapy. There were CR (complete response) 21 cases (42.9%), PR (partial response) 22 cases (44.9%) and MR/NR (minimal/no response) 6 cases (12.2%). No serious complication related to the technique occurred. Only 12 cases with asymptomatic PMMA leakage around 16 vertebrae were demonstrated on post-operative CT. Transarterial chemoembolization plus PVP is an effective and safe procedure in the treatment of severe painful vertebral and paravertebral metastatic tumors.