Combined Microwave Ablation and Osteosynthesis for Long Bone Metastases.

Claudio Pusceddu,Giuseppe Ruggiu,Giuseppe Dessì,Nicola Ballicu,Riccardo Cau,Luca Saba,Stefano Congia,Paolo Sailis,Ignazio Senis,Daniele Derudas,Alessandro Fancellu,Luca Melis

doi:10.3390/medicina57080825

Abstract

Background and Objectives: The purpose of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) in combination with open surgery nail positioning for the treatment of fractures or impending fractures of long bone metastases. Material and Methods: Eleven patients (four men, seven women) with painful bone metastases of the humerus, femur or tibia with non-displaced fractures (one case) or impending fractures (10 cases) underwent open MWA in combination with osteosynthesis by locked nail positioning. Pain intensity was measured using a VAS score before and after treatment. CT or MRI were acquired at one month before and 1, 3, 6, 12 and 18 months after treatment. Results: All procedures were successfully completed without major complications. The level of pain was significantly reduced one month after treatment. For the patients with humerus metastases, the complete recovery of arm use took 8 weeks, while for the patients with femoral metastases the complete recovery of walking capacity took 11 weeks. The VAS score ranged from 7 (4–9) before treatment to 1.5 (0–2.5) after treatment. During a mid-term follow-up of 18 months (range 4–29 months), none of the patients showed tumor relapse or new fractures in the treated site. Two patients died due to tumor disease progression. Conclusion: Results of this preliminary study suggest that combined MWA and surgical osteosynthesis with locked nails is a safe and effective treatment for pathological fractures or malignant impending fractures of long bone metastases of the humerus, femur and tibia. Further analyses with larger cohorts are warranted to confirm these findings.

Highlights

Long bones, in particular the femur, are the target of metastases frequently characterized by the occurrence of pain and pathological fractures [1]
Most of the metastatic lesions arising from breast, kidney or thyroid cancer, as well as from hematologic malignancies, are lytic and this subtype of metastases is associated with an increased risk of pathologic fracture [2,3]
Treatment of those metastatic lesions is warranted to reduce the risk of fracture and obtain pain control

Summary

Introduction

In particular the femur, are the target of metastases frequently characterized by the occurrence of pain and pathological fractures [1]. Most of the metastatic lesions arising from breast, kidney or thyroid cancer, as well as from hematologic malignancies, are lytic and this subtype of metastases is associated with an increased risk of pathologic fracture [2,3] Treatment of those metastatic lesions is warranted to reduce the risk of fracture and obtain pain control. Material and Methods: Eleven patients (four men, seven women) with painful bone metastases of the humerus, femur or tibia with non-displaced fractures (one case) or impending fractures (10 cases) underwent open MWA in combination with osteosynthesis by locked nail positioning. Conclusion: Results of this preliminary study suggest that combined MWA and surgical osteosynthesis with locked nails is a safe and effective treatment for pathological fractures or malignant impending fractures of long bone metastases of the humerus, femur and tibia. Further analyses with larger cohorts are warranted to confirm these findings

Objectives

Methods

Results

Conclusion