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      State-of-the-art of minimally invasive treatments of bone metastases

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          Highlights

          • Bone metastases are common in patients with malignant tumors and are highly dangerous.

          • Options for treatment of bone metastases are diverse, choosing the appropriate treatment is difficult.

          • Minimally invasive interventional procedures have less surgical trauma, fewer contraindications, high pain relief rate, and quicker patient recovery.

          • Interventional procedures are emerging as a novel and effective option for the treatment of bone metastases.

          Abstract

          Bone metastases is a common manifestation of advanced malignant tumors. With the recent advances in medical technology, the survival period of patients with malignant tumors is prolonged, and the probability of bone metastases is significantly increased. Approximately 70% to 80% of patients with breast or prostate cancer will eventually develop bone metastases. In addition, thyroid, lung, and kidney carcinomas are all known to cause bone metastases, with a 30% to 40% incidence upon postmortem assessment. Bone metastases often lead to severe pain, pathological fractures, and nerve damage and have become a critical factor affecting the quality of life and life expectancy of cancer patients. Although treatments for bone metastases are diverse, choosing the appropriate treatment is difficult. Both conservative treatment and open surgery have certain drawbacks and may not be appropriate for all patients. Interventional procedures have the advantages of less trauma with quicker recovery and represent a viable alternative. This review provides updates on the progress of research on the interventional treatment of bone metastases and directions regarding relevant further studies.

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          Most cited references113

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          Clinical features of metastatic bone disease and risk of skeletal morbidity.

          R Coleman (2006)
          The skeleton is the most common organ to be affected by metastatic cancer and the site of disease that produces the greatest morbidity. Skeletal morbidity includes pain that requires radiotherapy, hypercalcemia, pathologic fracture, and spinal cord or nerve root compression. From randomized trials in advanced cancer, it can be seen that one of these major skeletal events occurs on average every 3 to 6 months. Additionally, metastatic disease may remain confined to the skeleton with the decline in quality of life and eventual death almost entirely due to skeletal complications and their treatment. The prognosis of metastatic bone disease is dependent on the primary site, with breast and prostate cancers associated with a survival measured in years compared with lung cancer, where the average survival is only a matter of months. Additionally, the presence of extraosseous disease and the extent and tempo of the bone disease are powerful predictors of outcome. The latter is best estimated by measurement of bone-specific markers, and recent studies have shown a strong correlation between the rate of bone resorption and clinical outcome, both in terms of skeletal morbidity and progression of the underlying disease or death. Our improved understanding of prognostic and predictive factors may enable delivery of a more personalized treatment for the individual patient and a more cost-effective use of health care resources.
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            A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.

            Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use. We performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months' duration and unhealed, as confirmed by magnetic resonance imaging, were randomly assigned to undergo vertebroplasty or a sham procedure. Participants were stratified according to treatment center, sex, and duration of symptoms ( or = 6 weeks). Outcomes were assessed at 1 week and at 1, 3, and 6 months. The primary outcome was overall pain (on a scale of 0 to 10, with 10 being the maximum imaginable pain) at 3 months. A total of 78 participants were enrolled, and 71 (35 of 38 in the vertebroplasty group and 36 of 40 in the placebo group) completed the 6-month follow-up (91%). Vertebroplasty did not result in a significant advantage in any measured outcome at any time point. There were significant reductions in overall pain in both study groups at each follow-up assessment. At 3 months, the mean (+/-SD) reductions in the score for pain in the vertebroplasty and control groups were 2.6+/-2.9 and 1.9+/-3.3, respectively (adjusted between-group difference, 0.6; 95% confidence interval, -0.7 to 1.8). Similar improvements were seen in both groups with respect to pain at night and at rest, physical functioning, quality of life, and perceived improvement. Seven incident vertebral fractures (three in the vertebroplasty group and four in the placebo group) occurred during the 6-month follow-up period. We found no beneficial effect of vertebroplasty as compared with a sham procedure in patients with painful osteoporotic vertebral fractures, at 1 week or at 1, 3, or 6 months after treatment. (Australian New Zealand Clinical Trials Registry number, ACTRN012605000079640.) 2009 Massachusetts Medical Society
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              Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update.

              Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article . © RSNA, 2014.
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                Author and article information

                Contributors
                Journal
                J Bone Oncol
                J Bone Oncol
                Journal of Bone Oncology
                Elsevier
                2212-1366
                2212-1374
                19 March 2022
                June 2022
                19 March 2022
                : 34
                : 100425
                Affiliations
                [a ]Department of Orthopaedics, The First People’s Hospital of Nanning, Nanning, PR China
                [b ]Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, PR China
                Author notes
                Article
                S2212-1374(22)00015-X 100425
                10.1016/j.jbo.2022.100425
                8980625
                35391944
                d7f91c15-13aa-41eb-9234-9a8fd5969d3a
                © 2022 Published by Elsevier GmbH.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 22 November 2021
                : 17 March 2022
                : 17 March 2022
                Categories
                Review Article

                bone metastases,image guided,interventional treatment,minimally invasive surgical technology,research progress

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