Variety and results of the use of interventional oncoortopedic benefits for focal skeletal lesions

Introduction. The use of systemic drugs of special drug therapy in oncology is one of the key methods of treating patients including those with bone metastases. However, this does not always allow to eliminate the pain syndrome and avoid complications in the form of pathological fractures. Bone metastases often leave in the arsenal of oncologists’ mainly palliative agents, the main purpose of which is to reduce pain and improve the quality of life of patients.

Aim. To analyze the results of minimally invasive interventions in the volume of percutaneous vertebroplasty, osteoplasty and radiofrequency thermoablation.

Materials and methods. From 2015 to 2023, 488 patients on the basis of the Russian Scientific Center of Radioradiology underwent 716 interventional surgeries: 585 (81.7 %) percutaneous vertebroplastics, 103 (14.4 %) osteoplastics, 21 (2.9 %) radiofrequency thermoablasias, 7 (1 %) combined operations (radiofrequency thermoablasty + osteoplasty/vertebroplasty). Metastatic lesion was observed in 449 patients, benign tumors – in 38 (in 31 – hemangioma, in 7 – osteoid osteoma), borderline neoplasm (giant cell tumor) – in 1. Results were assessed by comparing measures of pain intensity in dependence on analgesic agents (by the visual analog scale (VAS) and Watkins scale), as well as motor activity levels (by the Eastern Cooperative Oncology Group (ECOG)) and neurological deficits (by the Frankel scale) before surgery, at the time of discharge and 3 months after surgery.

Results. In patients with metastatic bone damage 3 months after surgery, a mean decrease in the intensity of pain syndrome according to VAS was noted from 5.8 to 3.2 points, on the Watkins scale - from 7.2 to 5.7 points; ECOG functional status increased from 2.5 to 1.5 points. In 67 % of patients with neurological deficiency (class D by the Frankel scale), an increase in neurological status (class E by the Frankel scale) was observed. In all patients treated for osteoid osteoma, pain relief and restoration of functional status (0 points by the VAS and ECOG scales) were noted by the 6th month of follow-up.

Conclusion. According to the data obtained, the high effectiveness of the analgesic effect of interventional methods in patients with metastatic bone damage was noted. The use of vertebro- and osteoplasty allows to stabilize the affected segment of the skeleton (improve functional status and motor activity), and radiofrequency thermoablation – to achieve radicality of treatment in patients with osteoid osteoma.

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