Each year hundreds of thousands of cancer patients develop bone metastases, although the prevalence is estimated to be double the number of new cases [1]. Metastatic disease is also the most common malignancy of bone, and the most common primary tumours that account for 80% of skeletal metastases are prostate, breast, lung, kidney, and thyroid cancers [2]. Hence the scale of the clinical problem is substantial. The most common sites of bone metastases are in the axial skeleton mainly in the spine and pelvis [3]....

A comprehensive systematic review of the published literature was conducted to achieve the study aims. An electronic search of the Medline database retrieved 271 articles. All original articles investigating TAE of bone metastases for pain relief were included. Articles comparing TAE with radiotherapy were also included. Review articles were excluded. The possible sources of clinical heterogeneity of all included studies are analysed and presented. Primary outcome measure was pain relief rate. Data regarding primary tumour origin, anatomic site of metastases, embolic agents used, onset and...

Fifteen articles met the inclusion criteria representing 376 patients and 521 embolisation procedures (Table 1) [2, 4, 6-18]. The possibe sources of clinical heterogeneity of the included studies are presented in Table 2. The overall technical success rate was 97% (95% CI: 0.95-0.98). The average pain relief rate was 89% (95% CI: 0.85-0.91), the onset of pain relief ranged from a few hours to 15 days and lasted for a mean of 8.3 months (Table 3). Among the 521 TAE procedures the average rate of...

The management of patients with metastatic bone pain should be a multidisciplinary approach and includes the use of non-opioid and opioid analgesia, radiotherapy, surgery, chemotherapy, hormone treatment, radioisotopes and bisphosphonates. Evidence from this review strongly suggests that transcatheter arterial embolisation (TAE) should be added to the management algorithm of this group of patients. The treatment of choice should be selected on an individual patient basis. Embolisation of bone metastases for pain relief is safe and highly effective. TAE should be considered in symptomatic patients particularly...

Dr. Bahir Almazedi, MBChB, MRCS, FRCR, MSc Specialist Registrar in Radiology, Leeds and West Yorkshire Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.

1. Criteria for palliation of bone metastases - Clinical applications. Vienna, Austria: International Atomic Energy Agency, 2007 Contract No.: IAEA-TECDOC-1549. 2. Rossi G, Mavrogenis AF, Rimondi E, Braccaioli L, Calabro T, Ruggieri P. Selective embolization with N-butyl cyanoacrylate for metastatic bone disease. J Vasc Interv Radiol. 2011;22(4):462-70. 3. Wirbel RJ, Roth R, Schulte M, Kramann B, Mutschler W. Preoperative embolization in spinal and pelvic metastases. J Orthop Sci. 2005;10(3):253-7. 4. Forauer AR, Kent E, Cwikiel W, Esper P, Redman B. Selective palliative transcatheter embolization of...