Assessing the clinical efficacy of percutaneous acetabuloplasty in combination with radiotherapy for acetabular metastasis
10.3760/cma.j.cn121113-20230720-00016
- VernacularTitle:经皮髋臼成形术联合放疗治疗髋臼转移瘤的临床疗效
- Author:
Po LI
1
;
Peng ZHANG
;
Wen TIAN
;
Jiaqiang WANG
;
Xin WANG
;
Zhichao TIAN
;
Weitao YAO
Author Information
1. 河南省肿瘤医院（郑州大学附属肿瘤医院）骨与软组织科，郑州 450008
- Keywords:
Acetabulum;
Neoplasm metastasis;
Cementoplasty;
Radiotherapy;
Treatment outcome
- From:
Chinese Journal of Orthopaedics
2023;43(21):1418-1426
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the effectiveness of percutaneous acetabuloplasty (PA) in combination with radiotherapy for the treatment of acetabular metastases.Methods:A retrospective analysis of medical records from 43 patients with acetabular metastases admitted between May 2017 and May 2022 were performed, with 24 cases meeting inclusion criteria. The study cohort consisted of 9 males and 15 females, with an average age of 56.0 years (range: 40-85 years). There were 12 cases on the left side and 12 cases on the right side. The primary cancer types were breast cancer (8 cases, 33%), lung cancer (7 cases, 29%), prostate cancer (4 cases, 17%), bowel cancer (2 cases, 8%), cervical cancer (1 case, 4%), kidney cancer (1 case, 4%), and liver cancer (1 case, 4%). All patients had multiple bone metastases, with 16 cases (67%) also presenting with metastases in other organs. Among the bone metastases, 19 cases (79%) were osteolytic lesions, and 5 cases (21%) were mixed lesions. Lesion distribution included 11 cases in the acetabulum, 2 cases in the acetabulum and anterior column, 8 cases in the acetabulum and posterior column, and 3 cases in the acetabulum, anterior column, and posterior column. Lesion sizes ranged from 2.0 cm×1.5 cm×2.0 cm to 4.5 cm×4.0 cm×11.0 cm. Cortical defects were observed in 11 cases (46%), and soft tissue masses were present around the acetabular metastasis in 8 cases (33%). PA was performed under local or general anesthesia, followed by local radiotherapy within 1 week after surgery (external radiotherapy, 30 Gy, 10 d). Various clinical parameters, including primary lesion location, time of tumor diagnosis, time of bone metastasis diagnosis, number and nature of bone metastases, distribution area, lesion size, presence of cortical defects and soft tissue masses, presence of other organ metastases, surgical site, operation duration, filling effect, complications, visual analog scale (VAS) scores, walking scores, Eastern Cooperative Oncology Group (ECOG) scores, and long-term complications, were recorded and compared before surgery, after surgery, after radiotherapy, at 1, 3, and 6 months post-surgery, and during the last follow-up. The median follow-up period was 18 months.Results:Among the 24 patients, the procedure was successfully completed in 23 cases and failed in 1 case due to puncture needle-related complications. At the last follow-up, 92% (22/24) of patients showed no local symptom progression. VAS score, walking score, and ECOG score improved from 7.2±1.1, 1.4±1.4, 2.5±0.7 before surgery to 2.6±1.9, 2.5±1.4, 2.0±0.8 at 48 hours post-operation. There were no significant differences in scores between 48 hours post-surgery and 48 hours post-radiotherapy.Conclusion:PA can rapidly restore acetabular stability, alleviate pain, and enhance the quality of life for patients. In cases of poor response to PA, radiotherapy may not be effective, but it can effectively control local symptom progression. The combination of these two interventions can yield satisfactory clinical outcomes for patients with acetabular metastases.
