Osteoplasty has patients with metastatic bone disease walking again

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Miraculous results in some cases cause Turin radiologists to dub the treatment the “Lazarus effect”.

Osteoplasty—a highly effective minimally invasive procedure to treat the painful effects of metastatic bone disease by injecting bone cement to support weakened bones—provides immediate and substantial pain relief, often presenting individuals who are suffering terribly with the miraculous so-called “Lazarus effect,” said researchers at the Society of Interventional Radiology’s 34th Annual Scientific Meeting.

“The immediate good clinical results observed in our patients should encourage more widespread application of this palliative interventional radiology treatment,” said Giovanni C. Anselmetti, interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy.


“Osteoplasty is not a first-line treatment. It is a highly effective minimally invasive procedure that provides pain relief for patients not responding to conventional pain medication treatments,” he said. Interventional radiologists can improve the quality of life for patients who have very large metastases and who are going to die because of their primary cancers,” added Anselmetti.


Metastatic bone disease is a painful condition that occurs when cancer cells at an original site metastasise to the bone. These metastases can become widespread throughout the skeletal system. Some bone metastases become painful due to ostelolysis. If left untreated, bone metastases can eventually cause the bone to fracture and seriously affect a patient’s quality of life.


Technique


Osteoplasty involves the injection of semi-liquid bone cement (typically, polymethyl-methacrylate or PMMA) into a bone lesion under constant and precise visual monitoring by CT or digital fluoroscopy imaging. The technique is similar to vertebroplasty, an interventional radiology treatment that has been used extensively in the spine to treat the pain of compression fractures.


Research


Data presented by Anselmetti at SIR found that the average pain intensity score for patients based on the 11-point visual analog scale dropped significantly from 8.8 +/1.4 to 1.8 +/2.1 within 24 hours of osteoplasty, said Anselmetti. “These patients experienced immediate and substantial pain relief. They did not require pain medication during the time of follow-up, and there were no clinically significant complications,” said Anselmetti. Of 81 patients (59 women, 12 men), 64 (79 percent) were able to stop taking narcotic drugs for their pain, and 43 (53 percent) could stop taking other pain medication. In this study, pelvic, femur, sacrum, ribs, humerus, scapula, tibia, pubis and knee bones were treated.


Case study


In one case, Anselmetti recounted, a 79-year-old Roman Catholic nun had severe pain and was bedridden because of cancerous osteolytic lesions in her pelvis which were previously treated unsuccessfully with chemotherapy and radiotherapy.


She underwent osteoplasty and experienced significant relief of pain and was able to walk two hours after the procedure. “This is the ‘Lazarus effect’,” said Anselmetti, referring to the term often used to connote an apparent restoration to life, with Lazarus being the subject of the miracle recounted in the New Testament in which Jesus raises him from the dead. The nun, like other patients, was able to be discharged from the hospital on the same day.


Pain relief


“I cannot emphasise enough how important it is to provide relief to patients who are dying from their cancers. In most cases we can provide pain relief, restore function for them to do daily activities and help them to stay ambulatory,” said Anselmetti. He noted that osteoplasty provided effective pain regression for individuals with both painful bone metastases and benign lytic lesions that did not respond to conventional analgesic treatment.


For the most part, the goal of treating bone tumors is not curative, but rather palliative by reducing pain, preventing additional bone destruction and improving function.