Please see the Editorial Comment by Nicholas M. Beckmann discussing this article.

Abstract

Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.

Highlights

Musculoskeletal interventional oncology is an emerging field driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaborations.
Musculoskeletal interventional oncology techniques include ablation, osteoplasty, vertebral augmentation (with possible reinforcement via implants), osseous consolidation via percutaneous screw fixation, tumor embolization, and neurolysis.
The expanding array of minimally invasive image-guided treatments is increasingly used to provide safe, effective, and durable pain palliation and local control of musculoskeletal tumors.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Henley SJ, Ward EM, Scott S, et al. Annual report to the nation on the status of cancer. Part I. National cancer statistics. Cancer 2020; 126:2225–2249
2.
Macedo F, Ladeira K, Pinho F, et al. Bone metastases: an overview. Oncol Rev 2017; 11:321
3.
Urch C. The pathophysiology of cancer-induced bone pain: current understanding. Palliat Med 2004; 18:267–274
4.
Schulman KL, Kohles J. Economic burden of metastatic bone disease in the U.S. Cancer 2007; 109:2334–2342
5.
Gennaro N, Sconfienza LM, Ambrogi F, Boveri S, Lanza E. Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skeletal Radiol 2019; 48:1161–1169
6.
Deschavanne PJ, Fertil B. A review of human cell radiosensitivity in vitro. Int J Radiat Oncol Biol Phys 1996; 34:251–266
7.
Strander H, Turesson I, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 2003; 42:516–531
8.
van der Linden YM, Steenland E, van Houwelingen HC, et al.; Dutch Bone Metastasis Study Group. Patients with a favourable prognosis are equally palliated with single and multiple fraction radiotherapy: results on survival in the Dutch Bone Metastasis Study. Radiother Oncol 2006; 78:245–253
9.
Sze WM, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy: a systematic review of the randomised trials. Cochrane Database Syst Rev 2004; 2002:CD004721
10.
Johnstone C, Lutz ST. External beam radiotherapy and bone metastases. Ann Palliat Med 2014; 3:114–122
11.
Tsukamoto S, Kido A, Tanaka Y, et al. Current overview of treatment for metastatic bone disease. Curr Oncol 2021; 28:3347–3372
12.
Rose PS, Laufer I, Boland PJ, et al. Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol 2009; 27:5075–5079
13.
Cunha MVR, Al-Omair A, Atenafu EG, et al. Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys 2012; 84:e343–e349
14.
Hartung MP, Tutton SM, Hohenwalter EJ, King DM, Neilson JC. Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol 2016; 27:682–688.e1
15.
Jennings JW, Prologo JD, Garnon J, et al. Cryoablation for palliation of painful bone metastases: the MOTION Multicenter Study. Radiol Imaging Cancer 2021; 3:e200101
16.
Deschamps F, de Baere T, Hakime A, et al. Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 2016; 26:1631–1639
17.
Cornelis FH, Monard E, Moulin MA, et al. Sedation and analgesia in interventional radiology: where do we stand, where are we heading and why does it matter? Diagn Interv Imaging 2019; 100:753–762
18.
Morrison WB, Sanders TG, Parsons TW, Penrod BJ. Preoperative CT-guided hookwire needle localization of musculoskeletal lesions. AJR 2012; 176:1531–1533
19.
Tsoumakidou G, Saltiel S, Villard N, Duran R, Meuwly JY, Denys A. Image-guided marking techniques in interventional radiology: a review of current evidence. Diagn Interv Imaging 2021; 102:699–707
20.
Swarm RA, Youngwerth JM, Agne JL, et al. NCCN clinical practice guidelines in oncology (NCCN guidelines): adult cancer pain—version 1.2023. NCCN website. www.nccn.org/professionals/physician_gls/pdf/pain.pdf. Accessed Apr 23, 2023
21.
Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging; Shah LM, Jennings JW, Kirsch CFE, et al. ACR Appropriateness Criteria: management of vertebral compression fractures. J Am Coll Radiol 2018; 15(11S):S347–S364
22.
Mandel JE, Kim D, Yarmohammadi H, et al. Percutaneous cryoablation provides disease control for extra-abdominal desmoid-type fibromatosis comparable with surgical resection. Ann Surg Oncol 2022; 29:640–648
23.
Redifer Tremblay K, Lea WB, Neilson JC, King DM, Tutton SM. Percutaneous cryoablation for the treatment of extra-abdominal desmoid tumors. J Surg Oncol 2019; 120:366–375
24.
Kurtz JE, Buy X, Deschamps F, et al. CRYODESMO-O1: a prospective, open phase II study of cryoablation in desmoid tumour patients progressing after medical treatment. Eur J Cancer 2021; 143:78–87
25.
von Mehren M, Kane JM III, Agulnik M, et al. Soft tissue sarcoma, version 2.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2022; 20:815–833
26.
de Baere T, Tselikas L, Gravel G, et al. Interventional radiology: role in the treatment of sarcomas. Eur J Cancer 2018; 94:148–155
27.
Tillotson CL, Rosenberg AE, Rosenthal DI. Controlled thermal injury of bone: report of a percutaneous technique using radiofrequency electrode and generator. Invest Radiol 1989; 24:888–892
28.
Chu KF, Dupuy DE. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer 2014; 14:199–208
29.
Mehta TI, Heiberger C, Kazi S, et al. Effectiveness of radiofrequency ablation in the treatment of painful osseous metastases: a correlation meta-analysis with machine learning cluster identification. J Vasc Interv Radiol 2020; 31:1753–1762
30.
Levy J, Hopkins T, Morris J, et al. Radiofrequency ablation for the palliative treatment of bone metastases: outcomes from the multicenter OsteoCool tumor ablation post-market study (OPuS One Study) in 100 patients. J Vasc Interv Radiol 2020; 31:1745–1752
31.
Vikingstad EM, de Ridder GG, Glisson RR, et al. Comparison of acute histologic and biomechanical effects of radiofrequency ablation and cryoablation on periarticular structures in a swine model. J Vasc Interv Radiol 2015; 26:1221–1228.e1
32.
Callstrom MR, Dupuy DE, Solomon SB, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 2013; 119:1033–1041
33.
Tomasian A, Wallace A, Northrup B, Hillen TJ, Jennings JW. Spine cryoablation: pain palliation and local tumor control for vertebral metastases. AJNR 2016; 37:189–195
34.
Bouhamama A, Lame F, Mastier C, et al. Local control and analgesic efficacy of percutaneous cryoablation for desmoid tumors. Cardiovasc Intervent Radiol 2020; 43:110–119
35.
Cazzato RL, Gantzer J, de Marini P, et al. Sporadic desmoid tumours: systematic review with reflection on the role of cryoablation. Cardiovasc Intervent Radiol 2022; 45:613–621
36.
Filippiadis D, Efthymiou E, Tsochatzis A, Kelekis A, Prologo JD. Percutaneous cryoanalgesia for pain palliation: current status and future trends. Diagn Interv Imaging 2021; 102:273–278
37.
Abdo J, Cornell DL, Mittal SK, Agrawal DK. Immunotherapy plus cryotherapy: potential augmented abscopal effect for advanced cancers. Front Oncol 2018; 8:85
38.
Yakkala C, Chiang CLL, Kandalaft L, Denys A, Duran R. Cryoablation and immunotherapy: an enthralling synergy to confront the tumors. Front Immunol 2019; 10:2283
39.
Doshi A, Zhou M, Bui N, Wang DS, Ganjoo K, Hwang GL. Safety and feasibility of cryoablation during immunotherapy in patients with metastatic soft tissue sarcoma. J Vasc Interv Radiol 2021; 32:1688–1694
40.
Lubner MG, Brace CL, Hinshaw JL, Lee FT Jr. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21(suppl):S192–S203
41.
Vogl TJ, Nour-Eldin NEA, Hammerstingl RM, Panahi B, Naguib NNN. Microwave ablation (MWA): basics, technique and results in primary and meta-static liver neoplasms—review article. Rofo 2017; 189:1055–1066
42.
Zhang X, Ye X, Zhang K, et al. Computed tomography–guided microwave ablation combined with osteoplasty for the treatment of bone metastases: a multicenter clinical study. J Vasc Interv Radiol 2021; 32:861–868
43.
Deib G, Deldar B, Hui F, Barr JS, Khan MA. Percutaneous microwave ablation and cementoplasty: clinical utility in the treatment of painful extraspinal osseous metastatic disease and myeloma. AJR 2019; 212:1377–1384
44.
Khan MA, Deib G, Deldar B, Patel AM, Barr JS. Efficacy and safety of percutaneous microwave ablation and cementoplasty in the treatment of painful spinal metastases and myeloma. AJNR 2018; 39:1376–1383
45.
Bazzocchi A, Aparisi Gómez MP, Taninokuchi Tomassoni M, Napoli A, Filippiadis D, Guglielmi G. Musculoskeletal oncology and thermal ablation: the current and emerging role of interventional radiology. Skeletal Radiol 2023; 52:447–459
46.
Cazzato RL, Garnon J, Koch G, et al. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465
47.
Arrigoni F, Spiliopoulos S, de Cataldo C, et al. A bicentric propensity score matched study comparing percutaneous computed tomography-guided radiofrequency ablation to magnetic resonance-guided focused ultrasound for the treatment of osteoid osteoma. J Vasc Interv Radiol 2021; 32:1044–1051
48.
Bing F, Vappou J, de Mathelin M, Gangi A. Targetability of osteoid osteomas and bone metastases by MR-guided high intensity focused ultrasound (MRgHIFU). Int J Hyperthermia 2018; 35:471–479
49.
Tasu JP, Tougeron D, Rols MP. Irreversible electroporation and electrochemo-therapy in oncology: state of the art. Diagn Interv Imaging 2022; 103:499–509
50.
Cornelis FH, Ben Ammar M, Nouri-Neuville M, et al. Percutaneous image-guided electrochemotherapy of spine metastases: initial experience. Cardiovasc Intervent Radiol 2019; 42:1806–1809
51.
Bianchi G, Campanacci L, Ronchetti M, Donati D. Electrochemotherapy in the treatment of bone metastases: a phase II trial. World J Surg 2016; 40:3088–3094
52.
Shah LM, Salzman KL. Imaging of spinal metastatic disease. Int J Surg Oncol 2011; 2011:769753
53.
Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001; 27:165–176
54.
Yang PL, He XJ, Li HP, Zang QJ, Wang GY. Image-guided minimally invasive percutaneous treatment of spinal metastasis. Exp Ther Med 2017; 13:705–709
55.
Dupuy DE, Hong R, Oliver B, Goldberg SN. Radiofrequency ablation of spinal tumors. AJR 175:1263–1266
56.
Filippiadis DK, Marcia S, Ryan A, et al. New implant-based technologies in the spine. Cardiovasc Intervent Radiol 2018; 41:1463–1473
57.
Tutton SM, Pflugmacher R, Davidian M, Beall DP, Facchini FR, Garfin SR. KAST study: the Kiva system as a vertebral augmentation treatment—a safety and effectiveness trial: a randomized, noninferiority trial comparing the Kiva system with balloon kyphoplasty in treatment of osteoporotic vertebral compression fractures. Spine 2015; 40:865–875
58.
Cianfoni A, Distefano D, Scarone P, et al. Stent screw-assisted internal fixation (SAIF): clinical report of a novel approach to stabilizing and internally fixating vertebrae destroyed by malignancy. J Neurosurg Spine 2019; 32:1–12
59.
Noriega D, Marcia S, Theumann N, et al. A prospective, international, randomized, noninferiority study comparing an implantable titanium vertebral augmentation device versus balloon kyphoplasty in the reduction of vertebral compression fractures (SAKOS study). Spine J 2019; 19:1782–1795
60.
Cornelis FH, Razakamanantsoa L, Ben Ammar M, et al. Expandable intravertebral implant in cancer-related vertebral compression fractures: a retrospective review of 36 implantations. J Vasc Interv Radiol 2022; 33:14–18
61.
Korovessis P, Vardakastanis K, Vitsas V, Syrimpeis V. Is Kiva implant advantageous to balloon kyphoplasty in treating osteolytic metastasis to the spine? Comparison of 2 percutaneous minimal invasive spine techniques: a prospective randomized controlled short-term study. Spine 2014; 39:E231–E239
62.
Anselmetti GC, Manca A, Tutton S, et al. Percutaneous vertebral augmentation assisted by PEEK implant in painful osteolytic vertebral metastasis involving the vertebral wall: experience on 40 patients. Pain Physician 2013; 16:E397–E404
63.
La Barbera L, Cianfoni A, Ferrari A, Distefano D, Bonaldi G, Villa T. Stent screw-assisted internal fixation (SAIF) of severe lytic spinal metastases: a comparative finite element analysis of the SAIF technique. World Neurosurg 2019; 128:e370–e377
64.
Key BM, Scheidt MJ, Wooldridge AN, Sag AA, Tutton SM. Image guidance in osteoplasty and fixation. Tech Vasc Interv Radiol 2022; 25:100798
65.
Deschamps F, Farouil G, Hakime A, et al. Cementoplasty of metastases of the proximal femur: is it a safe palliative option? J Vasc Interv Radiol 2012; 23:1311–1316
66.
Lea WB, Tutton SM, Alsaikhan N, et al. Pelvis weight-bearing ability after minimally invasive stabilizations for periacetabular lesion. J Orthop Res 2021; 39:2124–2129
67.
Lea WB, Neilson JC, King DM, Tutton SM. Minimally invasive stabilization using screws and cement for pelvic metastases: technical considerations for the pelvic “screw and glue” technique. Semin Intervent Radiol 2019; 36:229–240
68.
Deschamps F, Yevich S, Gravel G, et al. Percutaneous fixation by internal cemented screw for the treatment of unstable osseous disease in cancer patients. Semin Intervent Radiol 2018; 35:238–247
69.
Dassa M, Roux C, Tselikas L, et al. Image-guided percutaneous fixation with internal cemented screws of impending femoral neck pathologic fractures in patients with metastatic cancer: safety, efficacy, and durability. Radiology 2020; 297:721–729
70.
Garnon J, Koch G, Ramamurthy N, et al. Percutaneous CT and fluoroscopy-guided screw fixation of pathological fractures in the shoulder girdle: technical report of 3 cases. Cardiovasc Intervent Radiol 2016; 39:1332–1338
71.
Poussot B, Deschamps F, Varin F, et al. Percutaneous fixation by internal cemented screws of the sternum. Cardiovasc Intervent Radiol 2019; 43:103–109
72.
Zoccali C, Attala D, Pugliese M, di Uccio AS, Baldi J. The IlluminOss photodynamic bone stabilization system for pathological osteolyses and fractures of the humerus: indications, advantages and limits in a series of 12 patients at 24 months of minimum follow-up. BMC Musculoskelet Disord 2021; 22:63
73.
Fourman MS, Ramsey DC, Newman ET, Raskin KA, Tobert DG, Lozano-Calderon S. How I do it: percutaneous stabilization of symptomatic sacral and periacetabular metastatic lesions with photodynamic nails. J Surg Oncol 2021; 124:1192–1199
74.
Johnston BR, Biercevicz AM, Koruprolu SC, Terek RM, Born CT. A biomechanical comparison of a novel expandable photodynamic intramedullary system to a metal plate and screw system in humerus and femur osteotomy models. Orthop Res Traumatol Open 2016; 1:5–13
75.
Facchini G, Parmeggiani A, Peta G, et al. The role of percutaneous transarterial embolization in the management of spinal bone tumors: a literature review. Eur Spine J 2021; 30:2839–2851
76.
Börüban S, Sancak T, Yildiz Y, Sağlik Y. Embolization of benign and malignant bone and soft tissue tumors of the extremities. Diagn Interv Radiol 2007; 13:164–171
77.
Guzman R, Dubach-Schwizer S, Heini P, et al. Preoperative transarterial embolization of vertebral metastases. Eur Spine J 2005; 14:263–268
78.
Heianna J, Makino W, Toguchi M, et al. Transarterial chemoembolization for the palliation of painful bone metastases refractory to first-line radio-therapy. J Vasc Interv Radiol 2021; 32:384–392
79.
Thiex R, Harris MB, Sides C, Bono CM, Frerichs KU. The role of preoperative transarterial embolization in spinal tumors: a large single-center experience. Spine J 2013; 13:141–149
80.
Basile A, Rand T, Lomoschitz F, et al. Trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of bone neoplasms. Cardiovasc Intervent Radiol 2004; 27:495–502
81.
Tang B, Ji T, Guo W, et al. Which is the better timing between embolization and surgery for hypervascular spinal tumors, the same day or the next day? A retrospective comparative study. Medicine (Baltimore) 2018; 97:e10912
82.
Filippiadis DK, Cornelis FH, Kelekis A. Interventional oncologic procedures for pain palliation. Presse Med 2019; 48:e251–e256
83.
Rossi G, Mavrogenis AF, Rimondi E, Braccaioli L, Calabrò T, Ruggieri P. Selective embolization with N-butyl cyanoacrylate for metastatic bone disease. J Vasc Interv Radiol 2011; 22:462–470
84.
Almazedi B. Embolisation of bone metastases for pain control: is it effective? European Society of Radiology website. epos.myesr.org/poster/esr/ecr2014/C-1334. Published 2014. Accessed May 8, 2023
85.
Yevich S, Tselikas L, Kelekis A, Filippiadis D, de Baere T, Deschamps F. Percutaneous management of metastatic osseous disease. Chin Clin Oncol 2019; 8:62
86.
Garnon J, Meylheuc L, Cazzato RL, et al. Percutaneous extra-spinal cementoplasty in patients with cancer: a systematic review of procedural details and clinical outcomes. Diagn Interv Imaging 2019; 100:743–752
87.
Gjorgjievska Delov A, Farrou G, Bouhamama A, Pilleul F, Mastier C. Tumoral dissemination along the screw trajectory in percutaneous osteosynthesis and cementoplasty: a non-described complication. Cardiovasc Intervent Radiol 2018; 41:336–339
88.
Filippiadis DK, Tutton S, Kelekis A. Percutaneous bone lesion ablation. Radiol Med (Torino) 2014; 119:462–469
89.
Masthoff M, Gerwing M, Schneider KN, et al. Combined transarterial embolization and percutaneous sclerotherapy as treatment for refractory and nonresectable aneurysmal bone cysts. J Vasc Interv Radiol 2021; 32:1425–1434.e2
90.
Pusceddu C, Sotgia B, Fele RM, Ballicu N, Melis L. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol 2016; 39:74–80
91.
Barzilai O, DiStefano N, Lis E, et al. Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: a clinical and dosimetric analysis. J Neurosurg Spine 2018; 28:72–78
92.
Kowalchuk RO, Johnson-Tesch BA, Marion JT, et al. Development and assessment of a predictive score for vertebral compression fracture after stereotactic body radiation therapy for spinal metastases. JAMA Oncol 2022; 8:412–419
93.
Hirsch AE, Jha RM, Yoo AJ, et al. The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures. Pain Physician 2011; 14:447–458
94.
Hellevik T, Martinez-Zubiaurre I. Radiotherapy and the tumor stroma: the importance of dose and fractionation. Front Oncol 2014; 4:1
95.
Di Staso M, Zugaro L, Gravina GL, et al. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol 2011; 21:2004–2010
96.
Di Staso M, Gravina GL, Zugaro L, et al. Treatment of solitary painful osseous metastases with radiotherapy, cryoablation or combined therapy: propensity matching analysis in 175 patients. PLoS One 2015; 10:e0129021
97.
Greenwood TJ, Wallace A, Friedman MV, Hillen TJ, Robinson CG, Jennings JW. Combined ablation and radiation therapy of spinal metastases: a novel multimodality treatment approach. Pain Physician 2015; 18:573–581
98.
Piras A, La Vecchia M, Boldrini L, et al. Radiofrequency thermoablation (RFA) and radiotherapy (RT) combined treatment for bone metastases: a systematic review. Eur Rev Med Pharmacol Sci 2021; 25:3647–3654

Information & Authors

Information

Published In

American Journal of Roentgenology
Pages: 503 - 516
PubMed: 37222277

History

Submitted: February 1, 2023
Revision requested: February 13, 2023
Revision received: April 19, 2023
Accepted: May 15, 2023
Version of record online: May 24, 2023

Keywords

  1. ablation
  2. musculoskeletal intervention
  3. vertebral augmentation

Authors

Affiliations

Brandon M. Key, MD [email protected]
Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226.
Matthew R. Callstrom, MD, PhD
Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226.
Dimitrios Filippiadis, MD
Department of Diagnostic and Interventional Radiology, University General Hospital “Attikon” Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Department of Radiology, Mayo Clinic, Rochester, MN.

Notes

Address correspondence to B. M. Key ([email protected], @bkeymd).
Version of record: Aug 9, 2023
B. M. Key is a consultant for Siemens Healthineers, and M. R. Callstrom is a consultant for Boston Scientific. The remaining author declares that there are no other disclosures relevant to the subject matter of this article.

Metrics & Citations

Metrics

Citations

Export Citations

To download the citation to this article, select your reference manager software.

There are no citations for this item

View Options

View options

PDF

View PDF

PDF Download

Download PDF

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media