Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom.
Semin Musculoskelet Radiol. 2020 Dec;24(6):692-709. doi: 10.1055/s-0040-1719103. Epub 2020 Dec 11.
Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.
肌肉骨骼（MSK）图像引导肿瘤介入是放射学领域的一个成熟领域。许多研究已经描述了其临床益处、安全性、成本效益、患者满意度和生活质量的提高，从而将图像引导肿瘤介入确立为治疗特定良性 MSK 肿瘤患者的首选途径。但目前出现了一种范式转变，因为这些技术也可能支持治疗恶性 MSK 肿瘤的既定支柱（手术、系统治疗、放射治疗）。与良性肿瘤不同，这些技术在具有治愈意图的情况下作为主要治疗线使用，对于恶性肿瘤，可以选择这些技术作为治疗疼痛或不稳定骨骼或软组织病变的辅助治疗方法，或者作为更姑息性的治疗策略。我们将通过临床实践中的例子详细阐述应用多学科方法（传统上涉及 MSK 放射科医生、肿瘤学家、骨科医生、微生物学家、病理学家、物理治疗师和疼痛管理专家）的益处，理想情况下是在肉瘤治疗中心内制定针对特定患者的治疗计划，并说明评估这种护理模式益处的方法。在本文中，我们回顾了当前的消融技术组合，展示了为什么这些手术为特定肿瘤的传统治疗提供了基于价值的替代方案，并反思了未来的发展方向。此外，我们还回顾了每种技术的优点和局限性，并提供了改进结果的指导。
