Bone Mass Changes Following Percutaneous Radiofrequency Ablation, Osteoplasty, Reinforcement, and Internal Fixation of Periacetabular Osteolytic Metastases
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Published:2023-07-11
Issue:14
Volume:12
Page:4613
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ISSN:2077-0383
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Container-title:Journal of Clinical Medicine
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language:en
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Short-container-title:JCM
Author:
Jiang Will1, Caruana Dennis L.1, Dussik Christopher M.1, Conway Devin1, Latich Igor2, Chapiro Julius2, Lindskog Dieter M.1ORCID, Friedlaender Gary E.1, Lee Francis Y.1
Affiliation:
1. Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA 2. Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, P.O. Box 208042, New Haven, CT 06520, USA
Abstract
Background: The success of orthopedic interventions for periacetabular osteolytic metastases depends on the progression or regression of cancer-induced bone loss. Purpose: To characterize relative bone mass changes following percutaneous radiofrequency ablation, osteoplasty, cement reinforcement, and internal screw fixation (AORIF). Methods: Of 70 patients who underwent AORIF at a single institution, 21 patients (22 periacetabular sites; average follow-up of 18.5 ± 12.3 months) had high-resolution pelvic bone CT scans, with at least one scan within 3 months following their operation (baseline) and a comparative scan at least 6 months post-operatively. In total, 73 CT scans were measured for bone mass changes using Hounsfield Units (HU). A region of interest was defined for the periacetabular area in the coronal, axial, and sagittal reformation planes for all CT scans. For 6-month and 1-year scans, the coronal and sagittal HU were combined to create a weight-bearing HU (wbHU). Three-dimensional volumetric analysis was performed on the baseline and longest available CT scans. Cohort survival was compared to predicted PathFx 3.0 survival. Results: HU increased from baseline post-operative (1.2 ± 1.1 months) to most recent follow-up (20.2 ± 12.1 months) on coronal (124.0 ± 112.3), axial (140.3 ± 153.0), and sagittal (151.9 ± 162.4), p < 0.05. Grayscale volumetric measurements increased by 173.4 ± 166.4 (p < 0.05). AORIF median survival was 27.7 months (6.0 months PathFx3.0 predicted; p < 0.05). At 12 months, patients with >10% increase in wbHU demonstrated superior median survival of 36.5 months (vs. 26.4 months, p < 0.05). Conclusion: Percutaneous stabilization leads to improvements in bone mass and may allow for delays in extensive open reconstruction procedures.
Reference39 articles.
1. Emerging Concepts in the Surgical Management of Peri-Acetabular Metastatic Bone Disease;Gazendam;Curr. Oncol.,2021 2. Modified Harrington’s procedure for periacetabular metastases in 89 cases: A reliable method for cancer patients with good functional outcome, especially with long expected survival;Kask;Acta Orthop.,2020 3. Surgical Management of Bone Metastases: Quality of Evidence and Systematic Review;Wood;Ann. Surg. Oncol.,2014 4. Prophylactic Percutaneous Consolidation of Large Osteolytic Tumors of the Pelvic Ring Using Fixation by Internal Cemented Screws;Assouline;Radiol. Imaging Cancer,2021 5. Maccauro, G., Liuzza, F., Scaramuzzo, L., Milani, A., Muratori, F., Rossi, B., Waide, V., Logroscino, G., Logroscino, C.A., and Maffulli, N. (2008). Percutaneous acetabuloplasty for metastatic acetabular lesions. BMC Musculoskelet. Disord., 9.
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