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Roux C, Tselikas L, Yevich S, Sandes Solha R, Hakime A, Teriitehau C, Gravel G, de Baere T, Deschamps F. Fluoroscopy and Cone-Beam CT-guided Fixation by Internal Cemented Screw for Pathologic Pelvic Fractures. Radiology 2018; 290:418-425. [PMID: 30422090 DOI: 10.1148/radiol.2018181105] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the safety and efficacy of palliative treatment of patients with pathologic pelvic by using fluoroscopy and cone-beam CT needle guidance software to perform percutaneous fixation by internal cemented screw (FICS). Materials and Methods This single-center study involved retrospective analysis of 100 consecutive patients with cancer with pathologic pelvic fractures managed with percutaneous FICS. Image guidance was performed with fluoroscopy and cone-beam CT needle guidance software. Pain palliative outcomes and opioid use after FICS were compared by means of paired-sample t test. Results A total of 107 percutaneous FICS procedures were performed from 2010 to 2017 to palliate 141 pathologic fractures in 100 patients (mean age, 65.0 years ± 17.6 [standard deviation; female age, 66.3 years ± 18.0; mean, 63.7 years ± 17.2]). Of 107 procedures, 104 (97.2%) were technically successful, with mean postprocedure hospitalization of 2 days ± 3. Complications occurred in 14 patients: focal pain at procedure site for longer than 48 hours (n = 5), hematoma (n = 3), progressive fracture despite fixation (n = 2), infection (n = 1), tumor track seeding (n = 1), and screw displacement (n = 2). In the 88 patients who completed early follow-up, mean numeric rating scale pain score was significantly improved at 6 weeks from 6.1 ± 2.5 to 2.1 ± 3.0 (P < .001). Opioid use was reduced at 6 weeks (preprocedure vs postprocedure, 91.3 g ± 121 vs 64.6 g ± 124, respectively; P = .04). Conclusion Fluoroscopy and cone-beam CT-guided percutaneous fixation of pathologic pelvis fractures by internal cemented screw is a safe and effective approach that can reduce pain and opioid use. © RSNA, 2018.
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Affiliation(s)
- Charles Roux
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Lambros Tselikas
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Steven Yevich
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Raphael Sandes Solha
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Antoine Hakime
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Christophe Teriitehau
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Guillaume Gravel
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Thierry de Baere
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Frederic Deschamps
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
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Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Advantages, Disadvantages, and Guidance. Clin J Pain 2016; 32:337-50. [PMID: 25988937 DOI: 10.1097/ajp.0000000000000255] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metastatic disease is the most common malignancy of the bone. Prostate, breast, lung, kidney, and thyroid cancer account for 80% of skeletal metastases. Bone metastases are associated with significant skeletal morbidity including severe bone pain, pathologic fractures, spinal cord or nerve roots compression, and malignant hypercalcemia. These events compromise greatly the quality of life of the patients. The treatment of cancer patients with bone metastases is mostly aimed at palliation. OBJECTIVE This article aims to present these palliative treatments for the patients with bone metastases, summarize the clinical applications, and review the techniques and results. METHODS It gives an extensive overview of the possibilities of palliation in patients with metastatic cancer to the bone. RESULTS AND DISCUSSION Currently, modern treatments are available for the palliative management of patients with metastatic bone disease. These include modern radiation therapy, chemotherapy, embolization, electrochemotherapy, radiofrequency ablation, and high-intensity focused ultrasound. As such it is of interest for all physicians with no experience with these developments to make palliative procedures safer and more reliable.
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