Clinical efficacy and safety of microwave ablation combined with percutaneous osteoplasty for palliative treatment in pelvic osteolytic metastases.

OBJECTIVES: To evaluate the impact of microwave ablation (MWA) on pain relief, quality of life, mobility, and local tumour progression in adult patients with pelvic osteolytic bone metastasis and to test the safety of MWA. METHODS: This study retrospectively analysed the data from 20 patients with pelvic osteolytic metastases who received MWA combined with percutaneous osteoplasty (POP). The visual analogue scale (VAS), musculoskeletal tumour society system (MSTS), and Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22) were used to evaluate the pain, limb function, and quality of life. The intraoperative and postoperative complications were recorded. The tumour recurrence and survival time were analysed during the follow-up period (range 3-26 months). RESULTS: All (n = 20) MWA and POP operations were completed successfully. Four patients (20%; 95% CI, 6%-44%) had mild bone cement leakage from surrounding tissues, and there were no obvious symptoms or serious complications. There were significant differences in VAS, MSTS, and QLQ-BM22 scores before and after the operation (P < .001). During the postoperative follow-up period, 9 patients died. The median survival time was 8 months (range 3-26 months; IQR: 4.5-13; 95% CI, 4.2-15.3 months), and the 1-year survival rate was 65% (13/20; 95% CI, 41%-85%). Tumour recurrence occurred in 4 cases (20%; 95% CI, 6%-44%) after the operation, and the median time of recurrence was 12 months (range 8-16 months; IQR: 8.25-12.75; 95% CI, 5.5-18.5 months). CONCLUSIONS: MWA combined with POP is an effective and safe treatment for pelvic osteolytic metastases. It can significantly relieve local pain, reconstruct limb function, improve patients' quality of life, and effectively control local tumour progression. ADVANCES IN KNOWLEDGE: So far, the experience of using microwave in the treatment of pelvic metastases is still limited. MWA combined with POP in the treatment of pelvic osteolytic metastases can provide significant clinical benefits in acceptable low-risk minimally invasive situations and should be provided to patients with appropriate pelvic metastases in a multidisciplinary approach.

Multisite Percutaneous Bone Augmentation for the Treatment of Acetabular Osteolytic Metastases Involving the Articular Surfaces: A Randomised Trial.

INTRODUCTION: For patients with acetabular osteolytic metastases involving the articular surfaces, current treatments cannot efficiently rebuild the acetabular bone frame structure and strengthen bone defect area mechanics for weight-bearing. The purpose of this study is to show the operational procedure and clinical outcomes of multisite percutaneous bone augmentation (PBA) for the treatment of incidental acetabular osteolytic metastases involving the articular surfaces. METHODS: According to the inclusion and exclusion criteria, 8 patients (4 males and 4 females) were included in this study. Multisite (3 or 4 sites) PBA was successfully performed in all patients. The pain and function evaluation and imaging observation were examined by VAS and Harris hip joint function scores at the different time points (pre-procedure, 7 days, one month, last follow-up in 5-20 months). RESULTS: There were significant differences (p<0.05) in VAS and Harris scores before and after the surgical procedure. Moreover, these two scores had no obvious changes during the follow-up process (7 days after the procedure, one month after the procedure, and the last follow-up) after the procedure. CONCLUSION: The proposed multisite PBA is an effective and safe procedure for the treatment of acetabular osteolytic metastases involving the articular surfaces.

Beyond Antiresorptive Activity: Risedronate-Based Coordination Complexes To Potentially Treat Osteolytic Metastases.

Coordination of clinically employed bisphosphonate, risedronate (RISE), to bioactive metals, Ca2+, Mg2+, and Zn2+, allowed the formation of bisphosphonate-based coordination complexes (BPCCs). Three RISE-based BPCCs, RISE-Ca, RISE-Mg, and RISE-Zn, were produced, and their structures were elucidated by single crystal X-ray diffraction. Interestingly, the addition of an auxiliary ligand, etidronic acid (HEDP), resulted in the recrystallized protonated form of the ligand, H-RISE. The pH-dependent structural stability of the RISE-based BPCCs was measured by means of dissolution profiles under neutral and acidic simulated physiological conditions (PBS and FaSSGF, respectively). In comparison to RISE (Actonel), the complexes showed a lower equilibrium solubility (∼70-85% in 18-24 h) in PBS, while a higher equilibrium solubility (∼100% in 3 h) in acidic media. The results point to the capacity to release this BP in a pH-dependent manner from the RISE-based BPCCs. Subsequently, the particle size of RISE-Ca was reduced, from 300 µm to ∼350 d.nm, employing the phase inversion temperature (PIT)-nanoemulsion method, resulting in nano-Ca@RISE. Aggregation measurements of nano-Ca@RISE in 1% fetal bovine serum (FBS):H2O was monitored after 24, 48, and 72 h to study the particle size longevity in physiological media, showing that the suspended material has the potential to maintain its particle size over time. Furthermore, binding assays were performed to determine the potential binding of nano-Ca@RISE to the bone, where results show higher binding (∼1.7×) for the material to hydroxyapatite (HA, 30%) when compared to RISE (17%) in 1 d. The cytotoxicity effects of nano-Ca@RISE were compared to those of RISE against the human breast cancer MDA-MB-231 and normal osteoblast-like hFOB 1.19 cell lines by dose-response curves and relative cell viability assays in an in vitro setting. The results demonstrate that nano-Ca@RISE significantly decreases the viability of MDA-MB-231 with high specificity, at concentrations ∼2-3× lower than the ones reported employing other third-generation BPs. This is supported by the fact that when normal osteoblast cells (hFOB 1.19), which are part of the tissue microenvironment at metastatic sites, were treated with nano-Ca@RISE no significant decrease in viability was observed. This study expands on the therapeutic potential of RISE beyond its antiresorptive activity through the design of BPCCs, specifically nano-Ca@RISE, that bind to the bone and degrade in a pH-dependent manner under acidic conditions.

Brown Tumors Secondary to Tertiary Hyperparathyroidism Masquerading as Lytic or Sclerotic Skeletal Metastases on Preoperative/Postoperative 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Case Report.

Tertiary hyperparathyroidism (TH) is a rare condition that develops from secondary hyperparathyroidism in cases when the secretion becomes autonomous. Brown tumors (BTs) are rare skeletal lesions of hyperparathyroidism that may mimic cancer metastasis. We report a case of a patient who was diagnosed with TH with multiple BTs which mimics osteolytic/osteoblastic metastases that were evaluated with two fluorodeoxyglucose positron emission tomography scans with an interval of 23 months in the preoperative and postoperative period.

The diagnostic value of X-ray, CT and MRI multimodal imaging in the vertebral compression fractures caused by osteolytic metastases and osteoporosis / 中国医师进修杂志

Objective:To analyze the diagnostic value of X-ray, CT and MRI multimodal images in the vertebral compression fractures caused by osteolytic metastases and osteoporosis.Methods:The basic clinical data and X-ray, CT, MRI imaging data of 102 patients with vertebral compression fractures from January 2019 to May 2021 in Jiangnan Hospital (Xiaoshan Traditional Chinese Medicine) Affiliated to Zhejiang University of Traditional Chinese Medicine were retrospectively analyzed. Among them, vertebral compression fractures caused by osteolytic metastases was in 47 cases, and vertebral compression fractures caused by osteoporosis was in 55 cases.Results:The age and osteoporosis rate in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: (61.95 ± 11.84) years old vs. (72.37 ± 12.55) years old and 4.3% (2/47) vs. 83.6% (46/55), the body mass index and pain visual analogue score were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: (22.58 ± 3.85) kg/m 2 vs. (18.11 ± 2.79) kg/m 2 and (8.31 ± 2.91) scores vs. (7.02 ± 2.72) scores, and there were statistical differences ( P<0.05); there was no statistical difference in gender composition ( P>0.05). The rates of vertebral body wedge shape and double concave shape in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: 2.80% (3/107) vs. 60.82% (104/171) and 6.54% (7/107) vs. 29.82% (51/171), the rates of flat shape and posterior margin swelling were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: 75.70% (81/107) vs. 9.36% (16/171) and 14.95% (16/107) vs. 0, and there were statistical differences ( P<0.01); the rates of pedicle involvement and soft tissue mass in patients with vertebral compression fractures caused by osteolytic metastases were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: 68.09% (32/47) vs. 1.82% (1/55) and 46.81% (22/47) vs. 0, while the rate of linear image signal in vertebral body was significantly lower than that in patients with vertebral compression fractures caused by osteoporosis: 0 vs. 96.36% (53/47), and there were statistical difference ( P<0.01); there was statistical difference in MRI signals ( P<0.01), vertebral compression fractures caused by osteolytic metastases were mainly characterized by low T 1 high T 2 and low T 1 low T 2, while vertebral compression fractures caused by osteoporosis was mainly characterized by low T 1 high T 2; the rates of disc compression and widening in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: 4.26%(2/47) vs. 34.55% (19/55) and 2.13%(1/47) vs. 18.18% (10/55), and there were statistical differences ( P<0.01 or <0.05). The accuracies of multimodal imaging in the diagnosis of vertebral compression fractures caused by osteolytic metastases and osteoporosis were significantly higher than those of X-ray, CT and MRI (89.4% vs. 51.1%, 72.3%, 83.0%; 90.9% vs. 52.7%, 60.0%, 78.2%), and there were statistical differences( P<0.05). Conclusions:Multimodal imaging is helpful to improve the diagnostic accuracy of vertebral compression fractures caused by osteolytic metastases and osteoporosis, to reduce the clinical misdiagnosis rate, with important reference value for the differential diagnosis of the two diseases.

Dynamic modeling of bone remodeling, osteolytic metastasis and PK/PD therapy: introducing variable order derivatives as a simplification technique.

Bone is constantly being renewed: in the adult skeleton, bone resorption and formation are in a tightly coupled balance, allowing for a constant bone density to be maintained. Yet this micro-environment provides the necessary conditions for the growth and proliferation of tumor cells, and thus bone is a common site for the development of metastases, mainly from primary breast and prostate cancer. Mathematical and computational models with differential equations can replicate this bone remodeling process. These models have been extended to include the effects of disruptive tumor pathologies in the bone dynamics, as metastases contribute to the decoupling between bone resorption and formation and to the self-perpetuating tumor growth cycle. Such models may also contemplate the counteraction effects of currently used therapies, and, in the case of treatments with drugs, their pharmocokinetics and pharmacodynamics. We present a thorough overview of biochemical models for bone remodeling, in the presence of a tumour together with anti-cancer and anti-resorptive therapy, formulated as systems of first-order differential equations, or simplified using variable order derivatives. The latter models, of which some are new to this paper, result in equations with fewer parameters, and allow accounting for anomalous diffusion processes. In this way, more compact and parsimonious models, that promptly highlight tumorous bone interactions, are achieved, providing an effective framework to counteract the loss of bone integrity on the affected areas.

Biomechanical Properties of Metastatically Involved Osteolytic Bone.

PURPOSE OF REVIEW: Skeletal metastasis involves the uncoupling of physiologic bone remodeling resulting in abnormal bone turnover and radical changes in bony architecture, density, and quality. Bone strength assessment and fracture risk prediction are critical in clinical treatment decision-making. This review focuses on bone tissue and structural mechanisms altered by osteolytic metastasis and the resulting changes to its material and mechanical behavior. RECENT FINDINGS: Both organic and mineral phases of bone tissue are altered by osteolytic metastatic disease, with diminished bone quality evident at multiple length-scales. The mechanical performance of bone with osteolytic lesions is influenced by a combination of tissue-level and structural changes. This review considers the effects of osteolytic metastasis on bone biomechanics demonstrating its negative impact at tissue and structural levels. Future studies need to assess the cumulative impact of cancer treatments on metastatically involved bone quality, and its utility in directing multimodal treatment planning.

[Painful orbital swelling in a 61-year-old female patient]. / Schmerzhafte Schwellung der Orbita bei einer 61-jährigen Patientin.

Adenocarcinoma of the esophagus is the oncologic entity with the most progressive incidence in western countries over the last 30 years. This is caused by, among other factors, a growing rate of obesity and the associated gastroesophageal reflux disease. Typical sites of metastasis include the liver, lymph nodes and peritoneum. Adrenal glands and thoraco-abdominal skeleton can also be affected. Cerebral metastasis is infrequent and there are only a handful cases described in the literature. The case presented here relates to a 61-year-old woman with osteolytic metastasis that was infiltrating the orbital cavity and was initially diagnosed as a dacryoadenitis.

[Vertebroplasty--state of the art]. / Vertebroplastie--"state of the art".

BACKGROUND: Percutaneous vertebroplasty (PVP) using PMMA (polymethyl methacrylate) was first described in 1987 by Gallibert and Deramond for the treatment of vertebral body instability in patients with aggressive forms of vertebral hemangioma. Other types of painful osteolytic bone lesions, such as osteoporotic vertebral fractures and vertebral metastasis are in the meantime more commonly treated using this method. METHODICAL INNOVATIONS: Within the last few years, this technique has become widely accepted and it is proposed for osteolytic bone lesions in areas that are more difficult to approach surgically, e.g., the pelvis and sacrum. EFFICACY: Rapid pain relief and resulting stability have conferred an important role upon osteoplasty especially in palliative tumor-treatment for patients with shortened expected life spans. In addition, combined treatment of painful osteolytic metastases with image-guided thermoablation and percutaneous cement injection has been shown to be a safe palliative modality in the therapy of nonresectable tumors.

CT Diagnosis of Osteolytic Metastases of the Vertebral Column / 实用放射学杂志

Objective To study CT value of diagnosis and identified diagnosis in osteolytic metastases of the vertebral column through describing their CT manifestation.Methods In 46 patients, 72 vertebrae osteolytic metastases were analyzed and compared with X-ray findings of 28 cases.Results In 72 vertebrae osteolytic metastases, there were destruction of 74 corpus vertebrae in 45 patients, of pediculus arcus vertebraes in 22 cases, of processus transverses in 15 cases, of processus spinosus in 11 cases and lamina vertebrae in 11 cases. Micrometastases were concentrated in corpus vertebrae(45/49). CT found the rate of bone-destruction, affection of vertebrae canal and soft tissue around vertebrae were 100%, 67.8% and 71.4%, but the corresponding rates were only 53.6%, 14.3% and 32.1% by X-ray. Conclusion Vertebral column metastases destructed corpus vertebrae at first, vertebral metastases are the origin or base of destruction of the pediculus arcus vertebrae, lamina vertebrae, processus transverses and processus spinous. CT scanning is more sensitive in finding and evaluating the lesions than X-ray plain film.