Clinical benefits of femoroplasty: a nonsurgical alternative for the management of femoral metastases.

BACKGROUND: Bone metastases occur frequently in advanced cancer. The spine, pelvis, ribs, skull and femur are the most affected sites. It is reported that up to 83% of the patients develop pain at some point of the disease. The patient can also develop fractures and disability, particularly in the femur.. OBJECTIVES: To evaluate the effectiveness of percutaneous femoroplasty in patients with metastatic osseous disease located in the proximal femur (trochanter, neck, and femoral head). STUDY DESIGN: A retrospective clinical review, comparing pain status "before vs after" intervention. SETTING: National Cancer Institute in Mexico. METHODS: We included patients over 18 years old, with mild to severe pain due to metastasis in the proximal femur (trochanter, neck, or head), or with a high risk of fracture according to Mirels scale (> 8 points) or severe osteoporosis according to the World Health Organization (a Karnofsky score more than 50%). Exclusion criteria were femoral fracture. We recorded the following variables age, sex, type of neoplasm, concomitant therapy, We used the Karnofsky functionality scale, the VAS pain intensity assessment, the "Mayo Clinic" scale to measure improved functionality, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTC QLQ-C15-PAL) (Spanish version) questionnaires. Follow-up was performed at 7 days, one month after femoroplasty, and during the individual outpatient that lasted one year on average. RESULTS: Eighty subjects were enrolled. Seventy-three percent were women. The most frequent tumors were breast (46.3%), followed by multiple myeloma (18.7%). All patients had a decrease in the intensity of pain, analgesic consumption, and improved quality of life, at 7 and 30 days after the intervention. There were no complications with serious consequences. Two participants experienced polymethylmetacrylate (PMMA) leakage, without clinical or functional impact. In 4 patients, the needle was occluded during the filling process and we had to place another biopsy needle through the same entry site to finish the injection process. LIMITATIONS: The sample was a single group of patients evaluated before and after the femoroplasty. We did not include a control group. CONCLUSION: The results of the current report suggest that femoroplasty, a percutaneous cement placement analogous to a vertebroplasty, might be a therapeutic option for patients with metastatic bone disease of the proximal femur, providing the patient an analgesic reduction and a better quality of life.

Femoroplasty: a new option for femur metastasis.

Bone metastases are very frequent in patients with cancer and usually are located in the patient's long bones and spine. Various approaches to pain relief and stability to the affected bone have been used. The aim of the study is to report our experience with a new minimally invasive percutaneous technique in patients with bone metastases located in the head, neck, and proximal femur. The technique is performed under fluoroscopic guidance through the application of polymethylmethacrylate bone cement. Our descriptive, retrospective, longitudinal case series included 15 patients who underwent femoroplasty. All patients reported pain reduction and improved mobility, with no complications observed. The femoroplasty procedure caused pain relief by stabilizing the bone through the consolidation of the microfractures because of bone metastases.

Management of chronic upper abdominal pain in cancer: transdiscal blockade of the splanchnic nerves.

BACKGROUND: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. MATERIALS AND METHODS: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction. RESULTS: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed. CONCLUSIONS: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications.