In some types of cancers, extensive destruction of bones is of primary importance. This damage may result in weakening of the bones and fractures (compression fractures), especially in the weight-bearing areas such as the spine. These fractures may cause severe pain, limitation of movement, and neurological problems if the fractured bones compress the spinal cord. In such patients, a special "cement" can be injected into the weakened area of the bone to strengthen the bone and collapse may be prevented. The patient's pain may also decrease as cement also kills the nerves in that area.
This procedure is called cementoplasty (when the cement is injected into the bone in any part of our body and vertebroplasty, when it is injected into the body of a vertebra. Cementoplasty, especially vertebroplasty, has been used for decades in the treatment and prevention of fractures due to osteoporosis, which is quite common in elderly women. In cancer patients, it is most commonly used in a bone marrow cancer called multiple myeloma. In multiple myeloma, bone resorption is increased and the patient frequently develops fractures in the bones especially in vertebrae. In these patients, vertebroplasty not only strengthens the vertebrae preventing further collapse but also reduces the pain caused by the compression. Vertebroplasty is more beneficial if it is performed early when the vertebrae are weakened but not yet collapsed. In such patients, vertebroplasty is technically easier and the collapse may be prevented before the spine is deformed. For this reason, patients with high risk, such as multiple myeloma, should be evaluated at regular intervals with CT or MRI and weakened bones with high risk of collapse should be identified and treated in good time. Because bone destruction is wide spread in patients with multiple myeloma, it is often necessary to perform multiple vertebroplasties.
Some cancers, such as lung, breast and thyroid cancer, often metastasize to the bones and spine. Pain and collapse may occur as a result of damage to the spine. In such patients, thermal ablation methods such as radiofrequency, microwave or cryoablation can be applied to the metastasis mass first, then vertebroplasty is performed through the same needle. The pain-reducing effects of both ablation and vertebroplasty may be increased when used together.
Interventional oncology in cancer management
Prof Saim Yilmaz, MD