Cryoablation of bone metastases from endocrine tumors

Congress:

ECR 2020

Poster Number:

C-10655

Type:

Educational Exhibit

Keywords:

Interventional Radiology, Bones, Interventional non-vascular, Musculoskeletal system, CT, MR, PET-CT, Ablation procedures, Radiation therapy / Oncology, Vertebroplasty, Cancer, Multidisciplinary cancer care, Outcomes, Retrospective, Not applicable, Performed at one institution

Authors:

R. M. C. D. Freitas¹, P. N. B. D. A. Araujo¹, R. Gianordoli Filho¹, A. O. Hoff¹, M. C. B. V. Fragoso¹, A. M. Sousa¹, C. A. Buchpiguel², J. G. M. P. Caldas¹; ¹São Paulo/BR, ²São Paulo, SP/BR

DOI:

10.26044/ecr2020/C-10655

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10655

Fig. 1

Fig. 8: Coronal view of a CT scan showingg a a sclerotic metastasis at the femoral...

Fig. 9: A Kirshner wire mounted in a surgical drill used to open the needle tract in...

Fig. 10: Fluoroscopic view sequence showing different cryoablation needle positioning -...

Fig. 11: CT scan coronal view with the remaining ice ball partially visualised in the...

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...