Management Of Bone Tumors Research Articles

Modular Universal Tumor and Revision System Prostheses in Patients with Bone Cancer of the Lower Limbs: A Narrative Review of Functional Outcomes.

The optimal management of bone tumors requires a multidisciplinary strategy to guarantee high-quality care. At specialized centers, the medical team responsible for managing patients with bone cancer comprises oncologists, surgeons, radiologists, pathologists, and rehabilitation specialists. The goal of treatment is to achieve long-term survival with minimal disability and pain. Postoperative rehabilitation is a fundamental therapeutic approach to enhance functionality and sustain the utmost quality of life following a limb-sparing surgery. Currently, megaprostheses are used for reconstructing bone defects after tumor resection, but in the literature, only a few studies have investigated rehabilitation outcomes in terms of functionality and impact on daily activities. This narrative review explores the functional and quality of life outcomes after the implantation of MUTARS® prostheses in patients with lower extremity bone tumors. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: "MUTARS", "Megaprosthesis", "bone", "tumors", "metastasis", "lower limb", "rehabilitation", "outcome", and "quality of life", and 10 studies were included. The most frequent oncological pathology was found to be primitive bone tumors treated with modular prostheses. The outcome measures used were the Henderson et al. classification, Harris Hip Scale, Musculoskeletal Tumor Society score, Visual Analog Scale, Range Of Motion, Karnofsky Performance Scale, and quality of life questionnaire. MUTARS® is a well-established treatment option after bone tumor resection, although it involves extensive and complex post-resection reconstruction that exposes joints and tissues to substantial mechanical stress. Proper rehabilitation after MUTARS® surgery is a fundamental therapeutic step, although there is still insufficient evidence in the literature focusing on functional and rehabilitative outcomes. Therefore, more studies and guidelines are needed to define standardized rehabilitation protocols for clinical practice after orthopedic oncologic surgery.

Impact of Psychological and Socioeconomic Factors on Management of Bone Tumours with Custom-made Endoprosthesis Reconstruction

Objectives: In the past few decades, the definitive treatment for bone tumours has evolved considerably. Resection followed by custom-made endoprosthesis reconstruction has become the standard of care. The main objective of this study is to analyse the psychological and socioeconomic factors impacting the treatment of bone tumours. Materials and Methods: Among the 53 patients who underwent bone resection with custom mega prosthesis (CMP) reconstruction between 2013 and 2022, 22 patients are in regular follow-up, 16 patients are lost in follow-up, and the remaining 15 are dead. We prepared a questionnaire which included 22 questions to assess the impact of psycho-social and economic factors on the treatment of bone tumours. Results: We included 22 patients in our study. The average total duration of disease before surgery was 95 days. The average days of in-hospital stay was 53 days. The average number of days of hospital stay after surgery was 14 days. The average amount spent during the hospital stay was about 240 Indian national rupees/day. The average loss of work was about 90 days. The average days of leave availed in school/college was 135 days. About 69.2% of patients had to go for a change of occupation. About 90.9% of patients had a fear of recurrence. About 77.2% of patients found it difficult to indulge themselves in recreational/sports activities. About 45.4% of patients felt it was difficult for their partner/family to empathise with their situation. About 59% of patients had sleep difficulties. About 36.3% of patients were well satisfied with their prosthesis. Conclusion: Being predominantly a disease of the young population, the need for comprehensive management, including psychological counselling and rehabilitation in addition to cancer treatment, seems to be the need of the hour. The fact of the high cost of non-treatment-related expenditure needs to be addressed. A frequent cancer survivor programme will aid these patients to regain their self-confidence.

Formulation and characterization of a novel anti-human bone cancer supplement from silver nanoparticles green-synthesized using Allium sativum l. Leaf aqueous extract

Several studies have recently uncovered the ability of plants to enhance the therapeutic efficacies of Ag NPs on various carcinoma cells, particularly those associated with human bone tumors. Developing and formulating novel chemotherapy supplements or medications for the management of bone tumors in humans is a top research focus for both developing and developed nations. Our current study involved the development of a contemporary chemotherapeutic medication utilizing silver nanoparticles (AgNPs) combined with an aqueous extract of Allium sativum L. for the purpose of treating bone tumors in humans. AgNPs were characterized using XRD, TEM, UV–Vis, and FE-SEM. The peaks detected at 2θ values of 77.4, 65.1, and 37.8 were associated with the crystal planes 311, 220, and 111, respectively. To examine the antioxidant characteristics of AgNPs, the DPPH assay was employed with BHT serving as the positive control. The MTT assay was employed to examine the anti-human bone tumor and cytotoxicity properties of AgNPs on bone cancer cells, including A-673 and HS-729 (rhabdomyosarcoma), MHH-ES1 and CADO-ES1 (Ewing’s sarcoma), MG-63 and HOS (osteosarcoma), as well as CH-3573 and SW-1353 (chondrosarcoma). The DPPH assay demonstrated comparable antioxidant capacities among AgNPs, and butylated hydroxytoluene. The anti-human bone tumor properties and cell viability of silver nanoparticles exhibited a dose-dependent decrease against CH-3573, SW-1353, MG-63, HOS, MHH-ES1, CADO-ES1, HS-729, and A-673 cells, while showing no cytotoxic effects on the normal cell line. The viability of the cells and their response to the nanoparticles varied based on the dosage administered. The silver nanoparticles exhibited IC50 values of 154, 67, 129, 110, 124, 107, 70, and 81 µg/ml against H-3573, SW-1353, MG-63, HOS, MHH-ES1, CADO-ES1, HS-729, and A-673 cell lines, respectively. The HOS revealed the most effective outcome regarding anti-human bone tumor efficacies when treated with AgNPs, surpassing the results observed in other cell lines. Based on the aforementioned results, it is possible to utilize the silver nanoparticles with A. sativum extract for the management of various human bone tumors, particularly human bone rhabdomyosarcoma, human bone chondrosarcoma, human bone osteosarcoma, and human bone Ewing’s sarcoma.

Advancements in Photothermal Therapy Using Near-Infrared Light for Bone Tumors.

Bone tumors, particularly osteosarcoma, are prevalent among children and adolescents. This ailment has emerged as the second most frequent cause of cancer-related mortality in adolescents. Conventional treatment methods comprise extensive surgical resection, radiotherapy, and chemotherapy. Consequently, the management of bone tumors and bone regeneration poses significant clinical challenges. Photothermal tumor therapy has attracted considerable attention owing to its minimal invasiveness and high selectivity. However, key challenges have limited its widespread clinical use. Enhancing the tumor specificity of photosensitizers through targeting or localized activation holds potential for better outcomes with fewer adverse effects. Combinations with chemotherapies or immunotherapies also present avenues for improvement. In this review, we provide an overview of the most recent strategies aimed at overcoming the limitations of photothermal therapy (PTT), along with current research directions in the context of bone tumors, including (1) target strategies, (2) photothermal therapy combined with multiple therapies (immunotherapies, chemotherapies, and chemodynamic therapies, magnetic, and photodynamic therapies), and (3) bifunctional scaffolds for photothermal therapy and bone regeneration. We delve into the pros and cons of these combination methods and explore current research focal points. Lastly, we address the challenges and prospects of photothermal combination therapy.

Revolutionizing bone tumor management: cutting-edge breakthroughs in limb-saving treatments.

Limb salvage surgery has revolutionized the approach to bone tumors in orthopedic oncology, steering away from historical amputations toward preserving limb function and enhancing patient quality of life. This transformative shift underscores the delicate balance between tumor eradication and optimal postoperative function. Primary and metastatic bone tumors present challenges in early detection, differentiation between benign and malignant tumors, preservation of function, and the risk of local recurrence. Conventional methods, including surgery, radiation therapy, chemotherapy, and targeted therapies, have evolved with a heightened focus on personalized medicine. A groundbreaking development in limb salvage surgery is the advent of 3D-printed patient-specific implants, which significantly enhance anatomical precision, stability, and fixation. These implants reduce soft tissue disruption and the associated risks, fostering improved osseointegration and correction of deformities for a more natural and functional postoperative outcome. Biological and molecular research has reshaped the understanding of bone tumors, guiding surgical interventions with advancements such as genomic profiling, targeted intraoperative imaging, precision targeting of molecular pathways, and immunotherapy tailored to individual tumor characteristics. In the realm of imaging technologies, MRI, CT scans, and intraoperative navigation systems have redefined preoperative planning, minimizing collateral damage and optimizing outcomes through accurate resections. Postoperative rehabilitation plays a crucial role in restoring function and improving the quality of life. Emphasizing early mobilization, effective pain management, and a multidisciplinary approach, rehabilitation addresses the physical, psychological, and social aspects of recovery. Looking ahead, future developments may encompass advanced biomaterials, smart implants, AI algorithms, robotics, and regenerative medicine. Challenges lie in standardization, cost-effectiveness, accessibility, long-term outcome assessment, mental health support, and fostering global collaboration. As research progresses, limb salvage surgery emerges not just as a preservation tool but as a transformative approach, restoring functionality, resilience, and hope in the recovery journey. This review summarizes the recent advances in limb salvage therapy for bone tumors over the past decade.

A Systematic Review and Meta-Analysis of the Outcomes of Reconstruction with Vascularised vs Non-Vascularised Bone Graft after Surgical Resection of Primary Malignant and Non-Malignant Bone Tumors.

Vascularised bone grafting (VBG) and non-vascularised bone grafting (NVBG) are crucial biological reconstructive procedures extensively employed in the management of bone tumours. The principal aim of this study is to conduct a comparative analysis of the post-resection outcomes associated with the utilisation of vascularised and non-vascularised bone grafts. A comprehensive and systematic literature review spanning the years 2013 to 2023 was meticulously executed, utilising prominent online databases including PubMed/Medline, Google Scholar, and Cochrane Library. Inclusion criteria were restricted to comparative articles that specifically addressed outcomes pertaining to defect restoration following bone tumour resection via vascularised and non-vascularised bone grafting techniques. The quality of research methodologies was assessed using the Oxford Quality Scoring System for randomised trials and the Newcastle Ottawa Scale for non-randomised comparative studies. Data analysis was conducted using SPSS version 24. Key outcome measures encompassed the Musculoskeletal Tumour Society Score (MSTS), bone union duration, and the incidence of post-operative complications. This analysis incorporated four clinical publications, enrolling a total of 178 participants (comprising 92 males and 86 females), with 90 patients subjected to VBG and 88 to NVBG procedures. The primary endpoints of interest encompassed MSTS scores and bone union durations. Although no statistically significant distinction was observed in the complication rates between the two cohorts, it is noteworthy that VBG exhibited a markedly superior bone union rate (P<0.001). Our systematic evaluation revealed that VBG facilitates expedited bone union, thereby contributing to accelerated patient recovery. Notably, complication rates and functional outcomes were comparable between the VBG and NVBG groups. Moreover, the correlation between bone union duration and functional scores following VBG and NVBG merits further investigation. reconstruction techniques, vascularised bone grafting, non-vascularised bone grafting, bone tumor, resection.

Probiotic Biofilm Modified 3D‐Printing Scaffolds for Improving Chemo‐Immunotherapy of Bone Tumor and Promoting Osteogenesis

AbstractTumor recurrence and unfavorable bacterial biofilm formation on implants after bone tumor resection remain challenging in clinical settings. However, this dilemma also provides inspiration for the development of bioactive implants and a new route for the management of bone tumors through biofilm formation. Here, based on the characteristic that bacteria prefer to adhere to implants, 3D‐printing bioceramic scaffolds modified with probiotic biofilms are designed to augment antitumor immunity. In comparison with Akkermansia muciniphila, Lactobacillus rhamnosus GG (LGG) is demonstrated to more easily form biofilms on bioceramics and is selected to engineer etched bioceramics. The LGG biofilm subjected to pasteurization guarantees good biocompatibility and enhanced doxorubicin (Dox) loading. Furthermore, the LGG biofilm combined with Dox imparts the scaffolds with multiple properties of direct chemo‐killing for tumor cells and potent immune activation. The modified scaffolds efficiently inhibit bone tumor recurrence and bone metastasis in murine tumor model receives surgical resection. Moreover, based on 3D‐printing technology, the probiotic biofilm modified scaffolds with adjustable shapes are also demonstrated to repair shape‐specific bone defects after tumor elimination. Collectively, the multifunctional 3D‐printing scaffolds realize the integrated treatment of tumor elimination and bone repair, providing a promising strategy for clinical treatment of bone tumors.

Interventional management of malignant bone tumours.

In the last few decades, interventional radiology (IR) has significantly increased its role in the management of bone tumours including bone metastases (BM) that represent the most common type of tumour involving the bone. The current IR management of BM is based on the 'palliative-curative' paradigm and relies on the use of consolidative (i.e. osteplasty, osteosynthesis) and/or ablation (i.e. cryoablation, radiofrequency ablation, electrochemotherapy) techniques. The present narrative review will overview the current role of IR for the management of BM.

Correction to: The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

Correction to: The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

The Ilizarov Method for the Management of Bone Tumors in the Lower Extremity: Techniques, Indications, and Outcomes

Outcomes Of Reconstruction With Vascularized Vs Non Vascularized Bone Graft After Resection Of Bone Tumours- A Systematic Review And Meta-Analysis.

Vascularized (VBG) and non-vascularized (NVBG) bone grafting are two crucial biological reconstructive techniques in the management of bone tumours. The objective of this study is to compare the outcomes of reconstruction with vascularized and non-vascularized bone grafts after resection of bone tumours. A systematic evaluation of the literature from 2012-2021 was undertaken using the online databases PubMed/Medline, Google Scholar, and Cochrane Library considering only comparative articles with specific outcomes for the restoration of the defect with vascularized and non-vascularized bone graft following the resection of bone tumours. The quality of the research methodology was evaluated using Oxford Quality Scoring System and Newcastle Ottawa Scale for randomized trials and non-randomized comparison research respectively. The SPSS version 23 was used to examine the data that was collected. Musculoskeletal tumour society score (MSTS), bone union time, and complications were the outcomes of this review. Four clinical publications were considered, totalling 178 participants (92 men and 86 women) with 90 patients with VBG and 88 with NVBG. MSTS score and bone union time were the key outcomes that were measured. The overall MSTS (p>0.05) and rate of complications (p>0.05) results were comparable between the two groups, however, VBG had a better rate of bone union (p<0.001). As a result of the quicker bone union, our systematic evaluation demonstrated that VBG causes earlier recovery. Complication rates and functional results were the same in both groups. The link between the bone union time and functional score following VBG and NVBG must also be demonstrated.

Imaging Recommendations for Diagnosis, Staging, and Management of Bone Tumors

AbstractPrimary bone sarcomas account for less than 1% of diagnosed cancers each year. In this era of multiplanar and functional imaging, the approach to the radiographic diagnosis of bone cancers goes much beyond traditional radiography. Radiographs are still the most pertinent part of the initial diagnosis of bone tumors. Multimodal imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), can help with issues such as complex anatomy, marrow assessment, soft assessment, and better local staging. The emerging imaging modality such as positron emission tomography (PET)-CT/PET-MRI has further transformed the imaging of bone malignancies. Radiologist plays an important role in the workup, staging, and management of bone tumors. The purpose of this article is to review imaging recommendations for better diagnosis, staging, and management of bone tumors.

The use of megaprosthesis in the treatment of proximal and distal femur nonunions in the elderly

Management of nonunion in the elderly patient are always a challenge for the orthopedic surgeon. The patient’s clinical condition is often critical, and normal nonunion management strategies are burdened with a high rate of failure. Megaprostheses have been designed for the management of bone tumors, but in the literature many cases of use in non-neoplastic conditions are described. They are, however, burdened by a high rate of complications, and in particular dislocations and periprosthetic infections. Proximal and distal femur replacement should therefore be considered as a salvage strategy to be used in the most severe cases of nonunion in the elderly patient.

Demographic, clinico-pathological features and management pattern of primary bone tumors in a tertiary care hospital of South India

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Primary bone tumors are very rare tumors. The true incidence of bone tumors is not well established and is under reported due to rarity and lack of accurate registries. Hence it is essential to study about the demographic, clinico-pathological features and the pattern of surgical management of bone tumors. The aim of this study is to analyze the demographic and clinico-pathological features of primary bone tumors that were managed by surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: A retrospective analysis of all patients with primary bone tumor who were treated by surgery from 2012 to 2019 was done. The age, sex distribution, histopathology, location of the tumor and surgical procedure done were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Among 103 patients analyzed, 66 (64%) were men and 37 (36%) were women. Primary bone tumors most commonly presented in 11 to 20 years of age with 35 (33.9%) patients occurring in this age group. Osteosarcoma was the most common primary bone tumor and it occurred in 49 (47.6%) patients, out of which 34 (69.3%) patients were below 20 years of age. Giant cell tumor was the most common benign bone tumor and it occurred in 22 patients, out of which nine (40.9%) patients were of age 21 to 30 years. Distal femur was the most common site with 39 (37.9%) patients. The limb preservation rate for malignant appendicular bone tumors was 69.0%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: The diagnosis of bone tumor depends not only on histopathological features but also needs correlation with age, clinical features, tumor location and radiological features for confirmation of diagnosis.&lt;/p&gt;

Clinicopathologic Profile of Patients with Maxillofacial Tumors in a Tertiary Level Government Institution

Rationale: Bone tumors of the head and neck region are rare. Their occurrence, biologic behavior, and management can cause significant personal, social, behavioral and economic ramifications. The aim of this study was to describe the clinicopathologic profile of patients with maxillofacial tumors in a tertiary level government hospital. Methods: This was a retrospective, descriptive study over a five-year period (January 2013 to December 2018). Results: A total of 256 patients was included in the study, with females accounting for 53.5% and males for 46.5%. The mean age of presentation was 37.4 years with a range of 18-80 years. The mean age of patients with benign tumors was 36.1 years, while those with malignant tumors was higher at 61.8 years. Majority of the tumors involved the mandible. Ameloblastoma and dentigerous cysts were the most prevalent benign odontogenic tumors while squamous cell cancer was the most common malignancy. Radical surgery with composite reconstruction was done in malignant cases to ensure adequate pathologic margins, while a more conservative tissue-sparing approach was done for benign cases. Conclusion: Management of maxillofacial tumors remains a challenge because of its relative anatomic location and locally advanced state upon detection. Identifying these tumors at an early stage ensures adequate resection with minimal functional and aesthetic loss. The low morbidity and mortality rates reported in this study emphasizes the role of the multidisciplinary team approach, surgical experience and comprehensive perioperative care in the management of bone tumors in the head and neck. Key words: odontogenic tumors, oral cavity, maxillectomy, mandibulectomy, ameloblastoma, maxillofacial surgery, squamous cell carcinoma

Bone Tumors Management Survey in India – Radiologist Perspective

Bone tumors are rare and the management of these in India is variable. We did a survey of the radiologists in India to assess the management of bone tumors. We discuss the results of the survey propose some guidelines and suggestion from a radiologist perspective.

Role of Trans-Arterial Embolization in Management of Bone Tumors

Abstract Background: Trans-arterial embolization (TAE) is a prom-ising less aggressive modality in either primary treatment or adjuvant to surgical management of bone tumors. The main aim is to induce necrosis and decrease bleeding and therefore facilitate resection. Palliation of compression manifestation of inoperable bone neoplasm is another indication of TAE. Frequent tumors selected to this modality include vascular tumors (particularly metastases), aneurysmal bone cysts (ABC), giant cell tumor (GCT), and osteosarcoma. Aim of Study: Our aim is to assess the role of embolization in management of bone tumors. Patients and Methods: The current study prospectively evaluated 33 patients (23 males and 10 females). Their age ranged from 9 to 69 years (mean age of 43.246±19.65). Extremities, hip, vertebrae, and skull were involved by variety of bony tumors. Sixteen patients were affected by primary osseous tumors, while 17 patients had metastases. A transar-terial embolization was done in all patients as a preoperative procedure in 15 patients, definite treatmentof primary benign inaccessible tumors in 6 patients, prebiopsy embolization in 6 patients, and as a palliative treatment in 6 patients. Results: Technical success was obtained in 30 out of 33 cases with percentage of 90.9%. All benign and primary malignant bony tumors showed technical success while, 82.4% of metastatic lesions did. Clinical success was achieved in 73.3% cases of first group, 83.3% of second group, 100% of third group and 66.7% of fourth group. Four patients (12.1%) showed no clinical improvement with 9% lost follow-up. Five out of 6 benign tumors showed clinical success (83.3%) as the sixth case lost follow-up (16.7%). Embolization of 9 of primary malignant lesions was clinically successful (90%), whereas 12 out of 17 metastatic lesions were improved clinically (70.6 %), 3 cases showed no clinical success (17.6%), and 2 cases were lost at follow-up (11.8%).Conclusion: A high consideration should be given totran-sarterialembolization in the algorithmic treatment strategy of bone tumors as it is much safer and effective tool when diminution of bleeding and compression manifestations is to be specifically aimed.

Controlled release of soy isoflavones from multifunctional 3D printed bone tissue engineering scaffolds

Recent challenges in post-surgical bone tumor management have elucidated the need for a multifunctional scaffold, which can be used for residual tumor-cell suppression, defect repair, and simultaneous bone regeneration. In this perspective, 3D printing allows to create a wide variety of patient-specific implant with complex porous architecture and compatible mechanical strength to that of cancellous bone. Here, a multifunctional bone graft substitute is designed by incorporating the three primary soy isoflavones: genistein, daidzein, and glycitein onto a 3D printed (3DP) tricalcium phosphate (TCP) scaffolds with designed pores, endowing them with in vitro chemopreventive, bone-cell proliferating and immune-modulatory potential. The interconnected porosity and biodegradability of 3DP TCP ceramics have allowed controlled release kinetics of genistein, daidzein and glycitein in acidic and physiological buffer medium for 16 days, which is fitted with Korsmeyer-Peppas model. Presence of genistein, a well-known natural biomolecule shows a 90% reduction in vitro osteosarcoma (MG-63) cell viability and proliferation after 11 days. Meanwhile, daidzein, the other primary isoflavone, promotes in vitro cellular attachment and enhances viability and proliferation of human fetal osteoblast cell (hFOB). Furthermore, controlled release of genistein, daidzein, and glycitein from 3DP TCP scaffold demonstrates improved hFOB cell proliferation, viability, and differentiation in a dynamic flow-perfusion bioreactor, which is utilized to better simulate the clinical microenvironment. Finally, in vivo H&E staining confirms controlled co-delivery of genistein-daidzein-glycitein from 3DP scaffold carefully modulated neutrophil recruitment to the surgery site after 24 h of implantation in a rat distal femur model. These results advance our understanding towards multipronged therapeutic approaches utilizing synthetic bone graft substitutes as a drug delivery vehicle, and more importantly, demonstrate the feasibility of localized tumor cell suppression and bone cell proliferation for post-surgical defect repair application. Statement of SignificanceDesigned multimodal porosity of 3D printed TCP scaffold allows a controlled and sustained release of soy isoflavones, genistein, daidzein and glycitein in both physiological and acidic pH. Presence of genistein shows 90% reduction in vitro bone cancer cell viability and proliferation. Meanwhile, controlled release of genistein, daidzein, and glycitein from 3DP TCP scaffolds demonstrate improved osteoblast cell proliferation, viability, and differentiation in static and dynamic flow-perfusion bioreactor. Furthermore, H&E staining at 24 h post-surgical specimens from rat distal femur model shows neutrophil recruitment at the surgery site is significantly decreased, suggesting the anti-inflammatory property of soy isoflavones. This work provides deeper understanding on the design of a multifunctional 3D printed patient-specific scaffold with enhanced in vitro chemopreventive, osteogenic and in vivo anti-inflammatory ability.

Complications Following Percutaneous Image-guided Radiofrequency Ablation of Bone Tumors: A 10-year Dual-Center Experience.

Background Percutaneous radiofrequency ablation (RFA) is effective in the management of bone tumors. However, knowledge of the complication rate and risk factors for complications of RFA is lacking. Purpose To report the complication rate and risk factors of bone tumor RFA. Materials and Methods This retrospective study reviewed complications in consecutive patients who underwent RFA of primary or metastatic bone tumors from January 2008 to April 2018. Complications were categorized into major (grade 3 or 4, severe or life-threatening) or minor (grade 1 or 2, mild or moderate) according to Common Terminology Criteria for Adverse Events. Univariable and multivariable regression analyses were performed to identify variables associated with complications of RFA. Results A total of 169 patients (median age, 63 years; interquartile range, 55-73 years; 85 men) with 217 tumors were evaluated. The total complication rate was 30.0% (65 of 217; 95% confidence interval [CI]: 23.8%, 36.0%). The major complication rate was 2.3% (five of 217; 95% CI: 0.8%, 5.3%), with secondary fracture being the most frequent event (1.8% [four of 217]). The minor complication rate was 27.7% (60 of 217; 95% CI: 21.7%, 33.6%), with immediate postoperative pain being the most frequent event (18.0% [39 of 217]). Risk factors for all complications included tumor size greater than 3 cm (adjusted odds ratio [AOR], 2.4 [95% CI: 1.2, 4.5]; P = .03) and previous radiation therapy (AOR, 3.8 [95% CI: 2.0, 7.4]; P = .02). The only risk factor for minor complications was previous radiation therapy (AOR, 2.2 [95% CI: 1.0, 4.7]; P = .04). Conclusion Bone tumor radiofrequency ablation is safe, with a low rate of major complications mainly consistent with secondary fractures. Risk factors for complications are tumor size greater than 3 cm and previous radiation therapy. © RSNA, 2020 Online supplemental material is available for this article.

Iodine-125 seed implantation combined with arterial chemoembolization therapy for pain palliation in metastatic bone cancer: a retrospective study

ABSTRACTBone metastases are the most common sites for malignant tumors. Patients who failed to respond to initial first-line treatment with bisphosphonates usually suffer from extreme pain. The aim of this study was to observe the efficacy of arterial chemoembolization combined with Iodine-125 seed implantation in the treatment of bone metastatic cancer pain. All 14 patients with metastatic bone tumor wo failed first-line treatment underwent arterial chemoembolization the day before the implantation of the particles. A computer stereoscopic TPS was used to design the treatment plans, the number and dose of particles required for implantation. Pain relief was evaluated using several parameters such as Visual Analog Scale (VAS) and Verbal Rating Scales (VRS). Pain intensity was measured pre-operation and 1-week, 1-month, 3-month after the treatment. Meanwhile, we also assessed tumor size using computer tomography (CT). Pain palliation was observed in 35.7% (5/14), 57.1% (8/14), and 78.6% (11/14) of all patients at 1-week, 1-month and 3-month post treatment. Likewise, our analysis showed that the combination therapy resulted in a significant decrease of VAS score (6.71 ± 0.49 before treatment vs 3.36 ± 0.40 at 3 month post treatment) and overall responding rate of 92.0% using VRS pain assessment. Consistently, tumor size was reduced from 42.16 ± 10.32 before treatment to 29.11 ± 8.73 at 3 months post treatment. No serious complications were detected. Our study demonstrate that the combination of arterial chemoembolization and 125I particles resulted in evident pain relief and reduction of tumor burden, suggesting that the combination treatment could be a feasible and promising therapy for bone tumor management.