How—and when—to manage cancer pain with interventional radiology
Interventional radiologists play a substantial role in treating cancer patients with painful bone metastases, but those physicians need to ensure they’re considering a host of factors in their formula for palliative care, Steven Yevich, MD, MPH, and co-authors reported in the Journal of Radiology Nursing this month.
Bone metastases are common in patients with advanced breast, prostate, lung, colon and stomach cancers, Yevich and colleagues at the University of Texas wrote, but treating them is a “known clinical challenge.”
“[And] as advances in oncological treatments continue to extend overall survival in patients with cancer, the incidence of metastatic musculoskeletal disease and skeletal-related events will become more frequent,” the authors said.
Interventional radiologists are being increasingly included in the treatment process, Yevich et al. wrote, since they can offer pain relief through radiologic treatments like embolization, thermal ablation, vertebral augmentation, cementoplasty and percutaneous internal fixation. The researchers emphasized radiologists should just be part of a multidisciplinary care team, though, alongside oncologists, radiation oncologists and orthopedic surgeons.
Depending on tumor size, treatment goals and disease location, a combination of interventional radiology techniques and nonradiological management with surgical resection, amputation, local external beam radiotherapy or bone-modifying agents are thought to ease patients’ pain.
“For patients, the goals of pain control and the maintenance of activities of daily living are paramount,” Yevich and colleagues wrote. “For the clinical treatment team, meeting the patient’s goals can translate to improvements in the patient’s quality of life, decreased opioid dependence, decreased likelihood of immobility-associated morbidity and lower overall healthcare costs.”
When considering which interventional radiologic treatment might work for which patient, the authors suggest considering the following:
Embolization
- What it is: A fluoroscopy-guided technique that promotes occlusion of a tumor’s arterial blood supply through transcatheter endovascular techniques.
- Who it’s best for: Patients with hypervascular bone tumors, the most common of which are renal and thyroid metastases.
- Why use it: Embolization works to “debulk” the tumor, subsequently providing pain relief by reducing compressive effects on the periosteum and adjacent nerves.
Percutaneous ablation
- What it is: In percutaneous thermal ablation, either extreme heat or extreme cold are directly funneled to the cancerous site with the goal of irreversible tumor cell death.
- Who it’s best for: Selection of ablation relies mostly on physician experience, anatomical considerations, patient comorbidities and tumor characteristics.
- Why use it: All thermal ablation modalities, including cryoablation, microwave ablation and radiofrequency ablation, provide relief by deconstructing sensory fibers that supply the periosteum, decompressing tumor volume, eradicating cytokine-producing tumor cells and inhibiting osteoclast activity.
Vertebral augmentation and cementoplasty
- What they are: Both methods aim to reinforce structurally weak bones by injecting them with bone cement, providing pain relief without cell death.
- Who they’re best for: Any patient with metastatic bone pain.
- Why use them: The physical qualities of bone cement—most commonly seen as the polymer polymethylmethacrylate—are thought to promote pain relief with resistance to axial compression forces and adhesion fixation of microfractures.
Percutaneous internal fixation
- What it is: A treatment used to stabilize an existing fracture or prevent an impending fracture by placing metallic screws through small skin incisions to span the fracture or large tumor.
- Who it’s best for: Nonsurgical candidates and patients with hard-to-access bone tumors.
- Why use it: To reduce pain and prevent further damage to the patient’s bones and body.
“Pain from bone metastases is a prevalent and difficult clinical problem that requires a multidisciplinary team approach,” Yevich et al. wrote. “It is important for providers to understand the goals of treatment for pain palliation.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.