Palliative embolization for osteosarcoma.
BACKGROUND
The prognosis of patients with metastatic, recurrent, and/or unresectable osteosarcoma is poor. Aggressive local and medical treatments are available for palliation. Palliative treatments include isolated limb perfusion, radiation therapy, embolization, chemoembolization, thermal ablation, and cryoablation. Their aim is pain relief and tumor size reduction with minimum complications.


METHODS
We present 19 patients with metastatic, recurrent, and/or unresectable osteosarcoma of the pelvis and lower lumbar spine treated with palliative selective embolization using N-2-butyl cyanoacrylate. All patients had chemotherapy. At the time of embolization, they experienced severe pain refractory to analgesics. Diagnostic angiography was performed pre-embolization to determine the vascular mapping and hemodynamic status of the tumor. Post-embolization angiography was done to evaluate for complete occlusion of the pathological vessels. Mean follow-up was 18 months. Local pain, tumor necrosis and size, and complications were recorded.


RESULTS
In all patients, pre-embolization angiography showed hypervascularity of the tumor from extensive neovascularization. Five patients had repeat embolization. All patients experienced pain relief at a mean of 3 days post-embolization. No patient had recurrent pain with the intensity of that before embolization. Variable tumor necrosis was observed in follow-up imaging, and reduction in tumor size was minimum. All patients experienced pain at the site of embolization, which resolved completely 1-5 days after embolization. Four patients with pelvic osteosarcomas experienced paraesthesias at the distribution of the sciatic nerve.


CONCLUSIONS
Selective arterial embolization is a useful local palliative treatment for patients with advanced osteosarcoma for pain relief.
First Department of Orthopaedics, Athens University Medical School, 41 Ventouri Street, 15562, Holargos, Athens, Greece, afm@otenet.gr.
Andreas F
AF
Mavrogenis
Giuseppe
G
Rossi
Eugenio
E
Rimondi
Teresa
T
Calabrò
Panayiotis J
PJ
Papagelopoulos
Pietro
P
Ruggieri
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D010384:Pelvic Bones / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D004659:Enbucrilate