Erik Bjorn Sviggum MD, Presenter: Nothing to Disclose

Anil Nicholas Kurup MD, Abstract Co-Author: Nothing to Disclose

Matthew Raymond Callstrom MD, PhD, Abstract Co-Author: Research Grant, Endocare, Inc Research Grant, Siemens AG

Peter Rose MD, Abstract Co-Author: Nothing to Disclose

Franklin Sim MD, Abstract Co-Author: Nothing to Disclose

To assess the viability of combined cryoablation and cementoplasty in palliating pain and preventing fracture in patients with lytic metastatic disease of the acetabulum.

39 combined cryoablation and cementoplasty procedures were performed on 37 patients with lytic acetabular metastatic disease from January 2004 through September 2012. Cryoablation was performed initally, with cementoplasty performed subsequently, usually the following day. Patient age ranged from 48 to 83 years (median 65, range 48-83). Patients included were known to have lytic periacetabular metastases that were painful, or nonpainful but extensive enough that there was concern of impending fracture. Nonpainful lesions were evaluated by orthopedic surgeons and deemed at risk for fracture prior to procedure. Pre-procedural pain rating, using a visual analog scale (VAS), was obtained by referring clinicians or the interventional radiologist. Lesion location, pain levels pre- and post-procedure, periacetabular fracture (defined as cortical discontinuity or fracture on CT or MRI) pre- and post-procedure, completeness of the ablation procedure, and pre- or post-ablative therapies (surgery, radiation) to the specific location were documented.

27 of the 39 procedures were done for palliation of pain and had complete pre- and post-procedural VAS pain scores. Of these patients, 23 (85%) had improved post-procedural pain scores. Patients who had complete cryoablation of their periacetabular metastases (defined as the ice ball completely encompassing the tumor as seen on intermittent CT fluoroscopy) had improved pain compared with patients who had incomplete cryoablations. Of the patients who received followup imaging of their pelvis, 69% had no progression of pre-existing fracture or development of new fracture. Lesion stability was slightly higher in patients who had complete cryoablations vs incomplete cryoablations (73% vs 57%). Only 4 of the 39 patients required a post-procedural intervention, including one patient who required sciatic neurolysis due to leakage of cement during the procedure.

Combined cryoablation and cementoplasty is a useful tool in the treatment of lytic acetabular metastatic disease for both palliation of pain as well as stabilization and prevention of fracture.

Combined cryoablation and cementoplasty can improve pain and stability in patients with lytic acetabular metastases.

Sviggum, E, Kurup, A, Callstrom, M, Rose, P, Sim, F, Palliation of Pain and Prevention of Fracture for Acetabular Metastases Using Combined Cryoablation and Cementoplasty.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015228.html