A few days ago, I saw a cancer friend asking: After bone metastasis, should I do "bone cement" and "bone ablation"?
I believe that many cancer friends are interested in this topic, bone metastasis is very common in patients with advanced cancer, and how to treat bone metastasis in a correct, timely and effective way is a problem that every patient urgently wants to know and pay attention to.
So what are "bone cement" and "bone ablation"? Do I have to do it after bone metastasis? Under what circumstances will "bone cement" and "bone ablation" be considered? Today we will take you to find out~
What is "bone cement" and "bone ablation"?
In fact, the "bone cement" treatment and the "bone ablation" treatment of bone metastasis are both minimally invasive interventional treatment techniques, simply put, under the guidance of imaging technology (such as ultrasound, CT, MRI, etc.), a needle (bone threading needle) is directly inserted from the skin into the bone (local anesthetics will be injected), and then various interventional treatments are performed.
1
"Bone cement"
"Bone cement" is a special material that is used specifically in the medical field and is also known as bone cement implants. It is mainly composed of polymethyl methacrylate (PMMA) and other components, which are highly adaptable to the human environment and have the characteristics of good biocompatibility, high strength stability, strong plasticity, fast hardening speed, and reversibility [1].
The "bone cement" treatment after bone metastasis refers to percutaneous osteoplasty (POP) for tumor bone metastasis, which is an interventional technique used to treat compression fractures and bone destruction caused by metastases by percutaneous puncture of diseased bone into the diseased bone under the guidance of image-guided percutaneous puncture of the diseased bone, and its main role is to increase bone strength, relieve pain, and prevent collapse.
These include percutaneous vertebroplasty (PVP) and balloon kyphoplasty (PKP), pelvic plasty, sacroanoperineal plasty, and bone cement perfusion for limb bone metastases. Cementoplasty in the vertebral body is the earliest and most widely used, and its mechanism is also the most deeply studied [2].
➤ How does the "bone cement" treatment kill tumor cells?
"Bone cement" treatment uses the mechanical compression of bone cement to form a mass effect, so that some tumor lesions lose blood supply and die, and the bone cement perfused around the diseased bone tissue forms an adhesive reinforcement and improves the stability of the bone. The monotoxicity and polymeric heat release effects of bone cement can cause necrosis of some tumor cells and nerve endings in the vicinity of the lesion, so as to achieve the purpose of treatment of bone metastasis [3].
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Featured topic: bone metastases
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2 "Bone Melting"
"Bone ablation" refers to the ablation treatment of bone metastases, which refers to the ablation needle punctured into the bone metastases under the guidance of imaging, and the bone metastases are "burned" or "frozen" by heating (radiofrequency ablation, microwave ablation, etc.) or cooling (argon-helium knife ablation), and the specific principles are as follows:
Radiofrequency ablation is a minimally invasive technique that inserts high-frequency alternating current into the tumor tissue through an electrode needle to destroy the nerve fibers of the tumor and its adjacent tissues, thereby inhibiting bone pain sensing and bone destruction, and at the same time creating a high-temperature and dry environment in the local tissues of the lesion, resulting in necrosis of the tumor tissue [4].
Microwave ablation uses high-frequency dipole vibrations to generate heat energy to kill tumor cells, thereby eliminating tumors [4].
Cryoablation (PCA) is a method of delivering cryogenic gases to the lesion site with a needle-thin argon-helium knife to accurately deliver cryogenic gases to the lesion site, causing tumor cells to form "ice balls", which then heat up rapidly to melt the ice balls and cause tumor cells to break up and die [4].
Under what circumstances will "bone cement" and "bone ablation" be considered?
1
"Bone cement"
Historically, percutaneous cementoplasty ("cement" therapy) was reserved for patients who were not candidates for open surgery, but the recent rise of imaging-guided minimally invasive techniques has broadened the scope of application of percutaneous cementoplasty, often in combination with local ablation therapy, as an alternative to surgery, for a variety of lytic bone primary tumors or bone metastases.
Studies have found that many patients benefit from this treatment, particularly in older and ill-looking patients who are no longer capable of traditional surgery but have severe symptoms that are more amenable to "cement" therapy [6].
However, patients with the following conditions are not candidates for "cement" therapy [5]:
(1) Severe neurological disease or poor general condition that is difficult to tolerate surgery and anesthesia;
(2) coagulation disorders that are difficult to correct;
(3) Tumor invasion of important organs, nerves, and blood vessels;
(4) active infection;
(5) The lesion has more than 5 metastases or extensive diffuse metastases.
2 "Bone Melting"
Ablation of bone metastases is often used to treat patients with bone metastases that have progressed; Patients who refuse radiotherapy or who still have pain after radiotherapy. In the National Comprehensive Cancer Network (NCCN) cancer pain guidelines, local ablation is now the recommended treatment for metastatic bone pain in the absence of orthopedic emergencies. In addition, ablation of bone metastases can be used instead of surgery in palliative care to preserve the function of the weight-bearing bone or prevent pathologic fractures [6]. Specific indications and contraindications are as follows [5]:
➤ Indications:
(1) Those who cannot tolerate surgery or refuse surgery or recurrence after refusing surgery or radiotherapy due to poor general condition;
(2) The number of lesions ≤ 5, and the edge of the lesions was ≥ 1cm away from the spinal cord, nerves and other important structures;
(3) Moderate to severe pain, pain score ≥ 4 points.
➤ Contraindications:
(1) Patients with severe liver, kidney, cardiopulmonary and cerebral insufficiency;
（2）严重的出血倾向，血小板计数<50×109/L。
All in all, with the update of minimally invasive concepts and the advancement of medical technology, the application of a variety of image-guided minimally invasive interventional therapy techniques in local control of bone metastasis, pain reduction and improvement of quality of life has gradually matured.
References:[1]Li Xiaofeng. "Bone cement" supports the backbone of the elderly[J].Family Medicine. Happy Health,2024,(04):7. [2] Liao Zhengyin, You Xin, Pu Ji. Chinese Journal of Pain Medicine,2011,17(12):714-718. [3] Zhou Zunwei, Li Huijian, Yin Zhiwei. Evaluation of the effect of percutaneous osteoplasty in the treatment of bone metastases[J].China Practical Medicine,2020,15(24):27-29.DOI:10.14163/j.cnki.11-5547/r.2020.24.010. [4] Liu Zhe, Yu Ling, Liu Xunwei, et al. Research progress on minimally invasive techniques based on percutaneous osteoplasty in the treatment of extravertebral bone metastasis[J].Journal of Medical Imaging,2023,33(07):1252-1254.) [5] Zhi Xiuyi, Wang Jie, Zhao Jun. Guidelines for the clinical diagnosis and treatment of bone metastasis of lung cancer in China (2024 edition)[J/OL].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,1-11[2024-05-16].http://kns.cnki.net/kcms/detail/51.1492.R.20240408.1735.002.html.[6]Dong Zhi, Zhao Jun, Liu Chen, et al. Expert consensus on the diagnosis and treatment of bone metastasis of lung cancer (2019 edition)[J].Chinese Journal of Lung Cancer,2019,22(04):187-207.)
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