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CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1735–1742 | Cite as

Palliative Percutaneous Cryoablation and Cementoplasty of Acetabular Metastases: Factors Affecting Pain Control and Fracture Risk

  • A. Nicholas Kurup
  • Grant D. Schmit
  • Thomas D. Atwell
  • Erik B. Sviggum
  • Wilfrido R. Castaneda
  • Peter S. Rose
  • Matthew R. Callstrom
Clinical Investigation
  • 92 Downloads
Part of the following topical collections:
  1. Non-Vascular Interventions

Abstract

Purpose

To characterize the response of patients with acetabular metastases following combined cryoablation and cementoplasty (CCC) for pain palliation and fracture risk reduction, based on completeness of ablation and the presence of pre-existing pathologic fracture.

Materials and Methods

Thirty-nine consecutive acetabular CCC procedures were performed in 37 patients (24 M:13F, age 66 ± 8 years). Pain was assessed using a 0–10 numeric rating scale. Development of new or progression of pre-existing fractures and local tumor progression (LTP) were determined on follow-up imaging. Pain score reduction and fracture development rates were compared by ablation completeness and the presence of pre-existing fractures.

Results

Twenty-three of 27 (85%) patients with evaluable pain scores had reduced pain, decreasing from 7.5 ± 2.1 to 3.6 ± 2.6 (p < 0.0001). Of 39 tumors, 28 (72%) were completely ablated with no significant difference in pain reduction after complete versus incomplete ablations (p = 0.9387). Six of 30 (20%) patients with follow-up imaging demonstrated new/progressive acetabular fractures. Four of 5 (80%) patients with LTP developed new/progressive fractures compared to 2 of 25 (8%) without tumor progression (p = 0.0003). Pre-existing fracture was not associated with subsequent fracture/fracture progression (p = 0.2986). However, patients with prior acetabular radiation therapy or surgery had increased fractures following treatment (p = 0.0380).

Conclusion

Complete acetabular tumor ablation during CCC was not associated with superior pain relief compared to subtotal ablation but did result in improved fracture stabilization. Pre-treatment pathologic fractures were not associated with fracture progression, but new/progressive fractures were more frequent in patients with prior radiation therapy or surgery.

Keywords

Acetabulum Cryoablation Percutaneous cementoplasty Palliative treatment Pathologic fracture 

Notes

Compliance with Ethical Standards

Conflict of interest

ANK and MRC receive royalties from UpToDate, Inc. and have received research support from Galil Medical. MRC also has received research grants from General Electric Medical Systems, Thermedical, and Siemens Medical. MRC is a paid consultant for Covidien.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • A. Nicholas Kurup
    • 1
  • Grant D. Schmit
    • 1
  • Thomas D. Atwell
    • 1
  • Erik B. Sviggum
    • 3
  • Wilfrido R. Castaneda
    • 4
  • Peter S. Rose
    • 2
  • Matthew R. Callstrom
    • 1
  1. 1.Department of Radiology (ANK, GDS, TDA, MRC)Mayo ClinicRochesterUSA
  2. 2.Department of Orthopedic Surgery (PRS)Mayo ClinicRochesterUSA
  3. 3.Department of Radiology (EBS)Mayo Clinic Health SystemEau ClaireUSA
  4. 4.Department of Radiology (WRC)Park NicolletSt. Louis ParkUSA

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