Use of Vertebroplasty in Oncologic Patients

M.D. Alie, V.V. Teplyakov, A.K. Valiev, V.Yu. Karpenko, O.M. Meluzova, R.A. Setdikov

(Oncologic Research Center of the Russian Academy of Medical Science, Moscow)

There were 50 cases, treated in the Oncologic Research Center in 2002-2004. A number was operations (vertebroplasty) for neoplastic osteolytic lesions of the spine in different primary and metastatic tumors was 58. There were 30 males (60%) and 20 females (40%). A mean age was 53 years (16-73). Morphologic types of tumors are given in Table 1.

Table 1

A Tumor Morphologic Type

A number of Cases

(%)

Hemangioma

15

30

Aneurysmal bone cyst

1

2

A giant cell tumor

1

2

Osteoporosis

2

4

Multiple myeloma

7

14

Lymphogranulomatosis

1

2

Lymphosarcoma

1

2

Metastasis of kidney cancer

10

20

Metastasis of mammary gland cancer

5

10

Metastasis of prostate cancer

1

2

Metastasis of lung cancer

1

2

Metastasis of rectum cancer

1

2

Metastasis of cervical carcinoma

1

2

Malignant hemangiopericytoma

1

2

Metastasis of cancer of unknown origin

1

2

Tuberculosis

1

2

Total

50

100

Patients with hemangiomas, metastatic kidney and mammary gland cancer were subject to vertebtoplasty (VP) most frequently.

VP was performed on the following levels: cervical 1 case (1.7%), thoracic 13 (22.4%), lumbar 40 (69.0%), lumbosacral - 4 (6.9%). It was made on 2 and 3 levels simultaneously in 3 (6%) and 1 (2%) cases respectively. A mean amount of injected cement was 5.5 ml (2.5-7 ml). Combined treatment was used in all the cases with malignant neoplasms and metastatic lesion. Its volume was determined with mandatory participation of a chemotherapist and a radiologist.

Intensity of pain syndrome was estimated on the basis of Watkins Scale before and after VP. The obtained data are given in Table 2.

Table 2

Watkins

Before (abs.)

(%)

After (abs.)

0

3

6

26

1

11

22

20

2

20

40

2

3

12

24

2

4

4

8

0

Results. Complete or considerable reduction of pain syndrome was watched in 46 cases (92%) during 48 hours after VP. Complications were watched in 2 cases (4%). Urgent decompressive laminectomy was performed in 1 female patient with a metastasis of kidney cancer; it was conditioned by cement penetration into a vertebral canal. Effective conservative treatment was carried out in one more female with radix compression by bone cement; the lesion was localized in a foramen area. A follow-up of 1-24 months did not reveal vertebra collapse after VP. There were 10 fatal outcomes (20%), caused by progression of the main disease.

Conclusions. VP is a little-invasive method. Its use results in considerable improvement of life quality due to partial or complete arrest of pain syndrome and prevention of pathologic fractures of vertebrae. Special treatment of metastatic can be started soon after VP.

In case of benign osteolytic processes, VP can be used as an independent modality or a method of choice.