Benhabib Hadas, Meirovich Harley, David Elizabeth
Department of Medical Imaging, University of Toronto.
Interventional Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Curr Opin Support Palliat Care. 2021 Jun 1;15(2):91-98. doi: 10.1097/SPC.0000000000000548.
Bone metastases are responsible for considerable morbidity, which can significantly limit a patient's quality of life. This article aims to review minimally invasive, image-guided locoregional treatments for symptomatic bone metastases as an adjunct to conventional treatment modalities.
Conservative therapy and radiation therapy (RT) can be effective at addressing pain, however, they require time to achieve optimal efficacy and do not address the instability and progressive collapse of pathological fractures. Vertebral and pelvic augmentation with cement enhances structural stability and can prevent progressive collapse and deformity. Ablative therapies, including radiofrequency ablation (RFA), cryoablation, and photodynamic therapy (PDT), induce cellular destruction of tumor tissue. RFA and PDT can be combined with cement augmentation in a single sitting.
Minimally invasive image-guided treatments can provide rapid pain relief, enhance mechanical stability, and improve quality of life. These treatments are associated with low complication rates and are suitable for frail patients. They can be used as companion procedures to conventional treatments, or function as an alternative for patients with radioresistant biologies or those with dose limitations from prior RT sessions.
骨转移会导致相当大的发病率，这会显著限制患者的生活质量。本文旨在综述针对有症状骨转移的微创、影像引导下的局部治疗，作为传统治疗方式的辅助手段。
保守治疗和放射治疗（RT）在缓解疼痛方面可能有效，然而，它们需要时间才能达到最佳疗效，并且无法解决病理性骨折的不稳定性和渐进性塌陷问题。用骨水泥进行椎体和骨盆强化可增强结构稳定性，并可防止渐进性塌陷和畸形。消融治疗，包括射频消融（RFA）、冷冻消融和光动力疗法（PDT），可诱导肿瘤组织的细胞破坏。RFA和PDT可在一次治疗中与骨水泥强化联合使用。
微创影像引导治疗可快速缓解疼痛，增强机械稳定性，并改善生活质量。这些治疗的并发症发生率低，适用于体弱患者。它们可作为传统治疗的辅助手段，或作为对放射抵抗生物学特性患者或因先前放疗疗程存在剂量限制患者的替代治疗方法。
