Scientific Abstracts: Thoracic, Renal, and Bone
Objective: The aim of our retrospective study was to evaluate feasibility, safety and efficacy of microwave ablation (MWA) in combination with open surgery nail positioning in the treatment of fracture or impending fractures of long bone metastases
Methods: 14 patients (10 men, 14 women) with painful bone metastases of the humerus (4 cases) and femur (10 cases) with non-displaced fracture (1 case) or impending fracture (13 cases) underwent open microwave ablation (MWA) in combination with osteosynthesis by blocked nail positioning. The metastases were located in the epiphysis or proximal and middle diaphysis with an intramedullary tumor component. Level of pain was measured using a VAS score before and after treatment. CT or MRI of the long bone were acquired within one month before and 1,3,6,12, 18 months after treatment. Once the access to the diaphyseal canal through trochitis for the humerus and through trochanter for the femur was prepared, a 14G microwave antenna, under fluoroscopic guidance, was positioned into the bone canal inside the tumor and MWA was performed. Before ablation, power level and exposure time were calculated based on the length and width of the metastasis. Immediately after ablation a nail was positioned to internal fixation. In the patient with fracture a reduction of it was performed before ablation.
Results: all procedures have been successfully completed without major complications. Level of pain has been significantly reduced one week after treatment. For the patients with humerus metastases the complete recovery of arm use was eight weeks and 11 weeks to recover the walking capacity for patients with metastasis of the femur. Was score ranged from 7 (4-9) before treatment to 1,5 (0 – 2,5) after treatment. During a medium follow-up of 18 months (from 4 to 29 months) none of the patients showed relapse of the tumor or new fractures in the treated site. Two patients died for lung and liver tumor progression.
Conclusions: Combined microwave ablation and surgical osteosynthesis with blocked nails is a safe and effective treatment of pathological fractures or malignant impending fractures of long bone metastases of the humerus or femur. However, further studies with a large series of patients are necessary to understand the exact role of this preliminary experience.