Interventional oncology: cryoablation in primary and metastatic disease involving bone

Congress:

ECR 2020

Poster Number:

C-11515

Type:

Educational Exhibit

Keywords:

Not applicable, Metastases, Treatment effects, Complications, Ablation procedures, SPECT-CT, MR, Fluoroscopy, Oncology, Interventional Radiology

Authors:

R. M. C. D. Freitas¹, R. Gianordoli¹, P. N. B. D. A. Araujo², M. C. B. V. Fragoso¹, A. O. Hoff¹, J. G. M. P. Caldas¹; ¹São Paulo/BR, ²São Paulo, RJ/BR

DOI:

10.26044/ecr2020/C-11515

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-11515

Fig. 28

Fig. 1: Metastatic adrenocortical carcinoma. Scintigraphy showing Technetium uptake in...

Fig. 2: (a) Coronal CT scan showing the cryoablation probe inserted in the proximal...

$Fig. 3: Plain X-ray of the proximal right femur showing a dynamic-hip-screw (DHS) system surgically implanted the following day after cryoablation of the trochanter in a 39 year old female patient with an adrenocortical carcinoma bone metastasis. DHS placement intended to prevent complications from bone fracture due to the weakened bone after cryoablation.$

Fig. 3: Plain X-ray of the proximal right femur showing a dynamic-hip-screw (DHS)...

Fig. 4: Recurrent metastatic adrenocortical carcinoma of the same patient after three...

Learning objectives

The aim of this exhibition wasto present the different roles of image-guided percutaneous cryoablation therapy in the treatment of primary and metastatic disease involving bone.

Background

Management of metastatic bone disease remains challenging. Current treatments available includes systemic therapies, external beam radiation and percutaneous ablation (cryoablation or radiofrequency ablation). Image-guided percutaneous cryoablation of primary and metastatic bone disease is an effective minimally invasive alternative to conventional therapies, for pain palliation and local tumor control. Extreme cold temperatures are achieved during bone cryoablation using Argon-based devices (about -150˚C). Such exposure during freezing cycles provides predictable lethal zones whereas no viable tumor cells persist. The efficacy of cryoablation occurs due to the direct...

Findings and procedure details

Illustrative cases from our department were presented withimaging, technique, changes seen after cryoablation, residual or recurrent disease and teaching points. CASE 1: Primary lesion and metastasis: A 39 year old femalepatient witha 6 cm metastic adrenocortical carcinoma in the proximal right femur (Fig. 1). Cryoablation procedures, complications and outcomes: Technique: cryoablation of the proximal femur was performed with the patient under general anesthesia. One cryoprobe was placed in the trochanter under fluoroscopy/MDCT guidance (Fig. 2a-c). A cytoreductive approach intended pain palliation. Therefore, three overlapping freezing...

Conclusion

CONCLUSION The management of primary tumors and bone metastases may be challenging. Pain, multiple lesions, risk of fracture, poor performance status are some of the reasons that hinder treatment. Cryoablation emerges as a safe and effective option to improve palliation and local tumor growth. In some cases, it can provide local complete treatment for primary musculoskeletal tumors or to help in the control of the metastatic bone disease.

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. Freitas;R. Gianordoli; P. N. B. Araujo;M. C. B. V. Fragoso; A. O. Hoff; São Paulo/BR; J. G. M. P. Caldas; São Paulo, RJ/BR - nothing to disclose

References

1. Si T, Guo Z, Yang X, et al. The oncologic results of cryoablation in prostate cancer patients with bone metastases. Int J Hyperthermia. 2018 Nov;34(7):1044-1048. 2. Ferrer-Mileo L, Luque Blanco AI, González-Barboteo J. Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review. Pain Pract. 2018 Nov;18(8):1083-1098. 3. Callstrom MR, Kurup AN. Percutaneous ablation for bone and soft tissue metastases--why cryoablation? Skeletal Radiol. 2009 Sep;38(9):835-9. 4.Freitas RMC, Menezes MR, Cerri GG, Gangi A. Sclerotic vertebral metastases: pain palliation using imaging-guided cryoablation. Cardiovasc Interv Radiol...