Abstract
Purpose
The aim of our study was to assess the efficacy and safety of percutaneous osteoplasty (PO), a technical extension of percutaneous vertebroplasty, in the treatment of extraspinal bone lesions from multiple myeloma causing pain resistant to NSAID therapy or treated with opioids.
Methods
Between March 2006 and January 2009, 39 patients (22 female), median age 64 years (range 48–88 years) with diagnosis of multiple myeloma, were treated with percutaneous osteoplasty for painful extraspinal bone lesions resistant to NSAID therapy or treated with opioids.
Results
Technical success was achieved in all cases. Mean visual analog pain score (VAS) scores dropped from 8.4 ± 1 (range 6–10; pretreatment) to 2.1 ± 1.7 (range 0–7; 24-h posttreatment). Pain completely disappeared in six (15%) patients. Administration of analgesics was suspended in 16 (41%) patients whereas in 17 (43.5%) patients previously treated with opioids, residual pain was controlled by NSAIDs. In six (15%) patients, narcotics administration was continued due to the persistence of pain. All patients completed an at least 6-month follow-up with a median long-term VAS score of 2.4 ± 2.1 (range 0–9). In five (13%) patients, pain remission was complete, with no recurrence at 18 months from treatment.
Conclusion
Our study suggests that PO may be feasible, effective, and safe in the treatment of conventional therapy-resistant extraspinal painful multiple myeloma lesions providing long-lasting pain relief with occasional tumor control and a significant reduction in the assumption of analgesic drugs.
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References
Mundy GR, Luben RA, Raisz LG, Oppenheim JJ, Buell DN (1974) Bone resorbing activity in supernatants from lymphoid cell lines. N Engl J Med 290:867–871
Mundy GR, Martin TJ (1982) The hypercalcemia of malignancy: pathogenesis and management. Metabolism 31:1247–1277
Valentin-Opran A, Charhon SA, Meunier PJ, Edouard CM, Arlot ME (1982) Quantitative histology of myeloma-induced bone changes. Br J Haematol 52:601–610
Yeh HS, Berenson JR (2006) Treatment for myeloma bone disease. Clin Cancer Res 12(20):6279S–6284S
Masala S, Anselmetti GC, Marcia S, Massari F, Manca A, Simonetti G (2008) Percutaneous vertebroplasty in multiple myeloma vertebral involvement. J Spinal Disord Tech 21(5):344–348
Diamond TH, Hartwell T, Clarke W, Manoharan A (2004) Percutaneous vertebroplasty for acute vertebral body fracture and deformity in multiple myeloma: a short report. Br J Haematol 124:485–487
Jensen ME, Kallmes DE (2002) Percutaneous vertebroplasty in the treatment of malignant spine disease. Cancer J 8:194–206
Farrar JT, Berlin JA, Strom BL (2003) Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage 25(5):406–411
Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2):149–158
Adamietz IA, Schöber C, Schulte RW, Peest D, Renner K (1991) Palliative radiotherapy in plasma cell myeloma. Radiother Oncol 20(2):111–116
Mill WB, Griffith R (1980) The role of radiation therapy in the management of plasma cell tumors. Cancer 45:647–652
Farhangi M, Ossermann EF (1973) The treatment of multiple myeloma. Semin Hematol 10:149–161
Anselmetti GC, Manca A, Ortega C, Grignani G, Debernardi F, Regge D (2008) Treatment of extraspinal painful bone metastases with percutaneous cementoplasty: a prospective study of 50 patients. Cardiovasc Interv Radiol 31(6):1165–1173
Basile A, Giuliano G, Scuderi V, Motta S, Crisafi R, Coppolino F, Mundo E, Banna G, Di Raimondo F, Patti MT (2008) Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol Med 113(7):1018–1028
Zhou B, Wu CG, Li MH, Gu YF, Cheng YD (2009) Percutaneous osteoplasty for painful sternal lesion from multiple myeloma. Skeletal Radiol 38(3):281–285
Dean JR, Ison KT, Gishen P (2000) The strengthening effect of percutaneous vertebroplasty. Clin Radiol 55:471–476
Deramond H, Wright NT, Belkoff SM (1999) Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 25(2):17S–21S
Zoarski GH, Snow P, Olan WJ, Stallmeyer MJ, Dick BW, Hebel JR, De Deyne M (2002) Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 13:139–148
Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 22:373–381
Tran Thang NN, Abdo G, Martin JB, Seium-Neberay Y, Yilmaz H, Verbist MC, Rufenacht D, Sappino AP, Dietrich PY (2008) Percutaneous cementoplasty in multiple myeloma: a valuable adjunct for pain control and ambulation maintenance. Support Care Cancer 16(8):891–896
San Millan RD, Burkhardt K, Jean B, Muster M, Martin JB, Bouvier J, Fasel JH, Rufenacht DA, Kurt AM (1999) Pathology findings with acrylic implants. Bone 25:85S–90S
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Masala, S., Volpi, T., Fucci, F.P.M. et al. Percutaneus osteoplasty in the treatment of extraspinal painful multiple myeloma lesions. Support Care Cancer 19, 957–962 (2011). https://doi.org/10.1007/s00520-010-0910-1
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DOI: https://doi.org/10.1007/s00520-010-0910-1