Learning objectives
To describe theindicationsfor percutaneouscryoablationof bone metastases from endocrine tumours
To report thetechnical aspectsof percutaneous cryoablation related to bone metastases from endocrine tumours
To highlight theresults of the procedure and the optimal setting for this therapyin the metastatic bone among other available methods of treatment
Background
Thyroid neoplasms, as well as adrenal and neuroendocrine tumours have the potential to metastasize to bone:
·Thyroid cancer incidencehas increased in developed countries over the past 30 years, with a three-fold increase in incidence rates, from 4.9 to17.6/100,000, while mortality rates kept relatively constant (~0.5 deaths/100,000). The increasing incidence of thyroid cancer has been suggested to be due to overdiagnosis, but more aggressive disease is not being removed by early detection.About 3% of patientswith well-differentiated thyroid carcinomaswill develop bone metastases.
·Neuroendocrine tumours (NETs)estimated prevalence is...
Findings and procedure details
Illustrative selected cases from our picture archiving and communication system (PACS) were reviewed.
Case 1:
A 27-year-old female patient with previous surgically treatedpheochromocytomareported a Visual Analogue Score (VAS) pain = 4 at the proximal right thigh. 123I-metaiodobenzylguanidine (MIBG) scintigraphy (Fig. 2)andMR imaging (Fig. 3 and Fig. 4)showed a unique focal lesion in the proximal femur. She presented with acute pulmonary oedema during a previous open surgical biopsy, probably due to catecholamine discharge secondary to manipulation of the metastasis.
Cryoablation technique
Preoperative alpha-blockadeand general anaesthesia with...
Conclusion
Bone metastases from endocrine tumours may be difficult to manage because of pain, poor performance status, orhormone production. Image-guided percutaneous cryoablation should be considered in the management of such patients. It may avoid local tumour progression and sequels such as cord / nerve compression, fractures, as well as an auxiliarymethod toreduce hormone production, alone or in combination with the other available therapies.
Personal information and conflict of interest
Contact details:
Ricardo Miguel Costa de Freitas
Instituto de Radiologia – InRad, Hospital das Clínicas da Universidade São Paulo
Rua Dr. Ovídio Pires de Campos, 75 - Cerqueira César
CEP: 05403-010 - São Paulo/SP, Brazil.
E-mail:
[email protected]
R. M. C. de Freitas; M. C. B. V. Fragoso; A. O. Hoff; A. M. Sousa; C. A. Buchpiguel; J. G. M. P. Caldas; São Paulo/BR - Research/Grant Support at FAPESP, Brazil(2018/01656-0)
P. N. B. Araujo; R. Gianordoli Filho; São Paulo/BR - nothing to disclose
References
1)Taal BG, Visser O (2004) Epidemiology of neuroendocrine tumours. Neuroendocrinology 80(Suppl 1):3–7
2)Loon KV, Zhang L, Keiser J, Carrasco C, Glass K, Ramirez M et al (2015) Bone metastases and skeletal-related events from neuroendocrine tumors. Endocr Connect 4(1):9-17. Doi: 10.1530/EC-14-0119
3)Olson E, Wintheiser G, Wolfe KM, Droessler J, Silberstein PT (February 24, 2019) Epidemiology of thyroid cancer: a review of the national cancer database, 2000-2013. Cureus 11(2): e4127. Doi:10.7759/cureus.4127
4)Sharma E, Dahal S, Sharma P, Bhandari A, Gupta V, Amgai B, Dahal S (2018) The...