06 May 2009

Bone cement eases cancer pain

Injecting "bone cement" into lesions in patients whose cancer has spread to their bones can allow these individuals to live the remainder of their lives relatively pain-free.


Injecting "bone cement" into lesions in patients whose cancer has spread to their bones can literally allow these individuals to rise from their deathbeds and live the remainder of their lives relatively pain-free.

Italian researchers presenting these findings at the Society of Interventional Radiology annual meeting in San Diego called it the "Lazarus Effect," referring to when Jesus miraculously raised Lazarus from the dead.

"The majority of treated patients experienced significant or complete and long-lasting pain relief after osteoplasty with immediate improvement of clinical conditions and quality of life," said study author Dr Giovanni Carlo Anselmetti, of the Institute for Cancer Research and Treatment in Turin.

Indeed, a 79-year-old nun who was confined to her bed because of thyroid cancer that had spread to her pelvis stood and walked just two hours after the minimally invasive procedure.

Dramatic improvements
"It is palliative. It's not going to be a curative procedure, but we've seen dramatic improvements in pain control," said Dr. Mark Montgomery, an associate professor of radiology at Texas A&M Health Science Center College of Medicine and director of interventional radiology and vice chair of education in radiology at Scott & White.

The procedure is more commonly used in the spine, said Dr Susan Bukata, an orthopaedic oncologist at the University of Rochester Medical Center.

Orthopedists who do osteoplasty generally partner with an interventional radiologist who first performs radiofrequency ablation (extreme heat) or cryoablation (freezing) to kill nerve cells near the tumour.

Osteoplasty involves injecting bone cement (here they used polymethyl-methacrylate or PMMA) into a bone lesion with the help of image guidance.

"The procedure is analogous to vertebroplasty, which has been around for a few years, where you put little needles into the spine and inject a cement mixture," Montgomery said. "It's the same kind of cement they use for total hip replacement. This is same thing, except they're just taking it to usage outside the spine into other areas."

The research study
This study involved 81 patients, aged 36 to 94 and mostly female, who underwent osteoplasty at least once. Seventy-four of the participants had cancer, while a handful had "benign" diseases such as rheumatoid arthritis.

The overall patient population was larger than those seen in other studies, Bukata said.

Pelvic, femur, sacrum, ribs, knee and other bones were treated.

The mean pain score dropped significantly within 24 hours of the procedure. Sixty-four of the patients (79%) were able to discontinue use of narcotics and 43 (53%) also stopped using any other pain medications. Only five of the patients showed no improvement in pain. There were no deaths or major complications.

The procedure could also be used to avoid massive surgery later in life, Bukata said.

"There's a lack of an awareness of some of the options for patients that have painful bone metastases," Montgomery added. "It's physician education as much as it is patient education."

(HealthDay News, April 2009)


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