European Conference on Interventional Oncology
ECIO countries

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

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ProgrammeSneak peeksIO +/- radiotherapy: when and where?

IO +/- radiotherapy: when and where?

Three reasons why you cannot miss my lecture

  1. You will learn why bone metastases are not just about pain but also entail neurological deficits and compromised mobility
  2. We will explore emerging treatment modalities such as stereotactic body radiation therapy (SBRT)
  3. You will gain an insight into structured therapy selection with the Wallace Algorithm

Dr. Stefano Marcia
Speaker bio
 

Add this session to your calendar!

Bone metastases present a significant challenge in oncology, often leading to severe pain, neurological deficits, and compromised mobility, thereby profoundly affecting patients’ quality of life. [1] The intricate vascular network and venous plexuses of the spine make it particularly susceptible to metastatic infiltration, exacerbating the burden of disease. The pathogenesis of metastatic bone pain involves biochemical nociceptor stimulation, periosteal inflammation, and the release of tumour-derived cytokines. [2]

A multidisciplinary approach to managing bone metastases is imperative for achieving optimal patient outcomes. [3] While conventional external beam radiation therapy (EBRT) remains the primary treatment modality for painful spinal metastases, its efficacy is variable, with a significant proportion of patients experiencing suboptimal pain relief and recurrence post-treatment. [4]

In response to these challenges, stereotactic body radiation therapy (SBRT) has emerged as a promising alternative, though associated with an increased risk of pathological fractures. [1]

When radiation therapy proves ineffective or is contraindicated, percutaneous tumour ablation offers a viable solution, targeting painful lesions, radio-resistant tumours, and instances of maximal radiation dosage. Interventional techniques such as radiofrequency ablation, microwave ablation, cryoablation, high-intensity focused ultrasound (HIFU), and vertebral augmentation provide acute pain relief while preserving chemotherapy regimens. [5]

Indications for ablation include painful lesions with impending fractures, persistent pain post-radiation therapy, and instances of radiotoxicity or bone marrow suppression. [6]

Vertebral augmentation, employing polymethylmethacrylate (PMMA), stabilizes weight-bearing bones and exerts direct cytotoxic and thermal effects on tumour cells and sensory nerves, reducing the risk of pathologic fractures. [7]

Integration of the Wallace Algorithm for patient therapy selection offers a structured approach to treatment decisions, considering factors such as life expectancy, performance status, tumour histology, and spinal instability. By incorporating this algorithm into clinical practice, healthcare providers can tailor therapies to individual patient needs, optimizing treatment outcomes and enhancing overall satisfaction. [1]

In summary, comprehensive management strategies for bone metastases encompass a multidisciplinary approach that integrates conventional and emerging treatment modalities. [8]

By adopting a structured approach to therapy selection and incorporating innovative techniques such as SBRT and percutaneous tumour ablation, healthcare providers can improve symptom control and enhance the overall quality of life for patients with bone metastases.

 

Stefano Marcia, Stefano Marini, Luca Piras, Chiara Zini, Cagliari/IT

Dr. Stefano Marcia completed his medical degree at the University of Cagliari in 1990 before focusing on a radiology specialization, which he completed in 1995. A lifelong learner, he has since earned both a Master’s of Endovascular Techniques and a Master’s of Health Management. Dr. Marcia currently serves as Head of Radiology, Head of Service Department, and Vice Medical Director at the ASL Cagliari in Sardinia. He is an active member of several scientific societies worldwide, has spoken at dozens of meetings around the globe, and has been a faculty member or invited speaker at CIRSE every year for the past decade. He is currently the president of the Groupe de Recherche Interdisciplinaire sur les Biomatériaux Ostéo-articulaires Injectables (GRIBOI) and the Sardinian group of the Italian Society of Medical Radiology (SIRM).

 

References

  1. The Metastatic Spine Disease Multidisciplinary Working Group Algorithms. Oncologist. Wallace AN, Robinson CG, Meyer J, Tran ND, Gangi A, Callstrom MR, Chao ST, Van Tine BA, Morris JM, Bruel BM, Long J, Timmerman RD, Buchowski JM, Jennings JW. 2015, pp. 20:1205-1215.
  2. Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Ratasvuori M, Wedin R, Keller J, Nottrott M, Zaikova O, Bergh P, Kalen A, Nilsson J, Jonsson H, Laitinen M. 2013, Surg Oncol. , pp. 22:132-138.
  3. Early palliative care for patients with metastatic non-small-cell lung cancer. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. s.l. : N Engl J Med., 2010, Vols. 363(8):733-42.
  4. UPDATE ON THE SYSTEMATIC REVIEW OF PALLIATIVE RADIOTHERAPY TRIALS FOR BONE METASTASES. Chow E, Zeng L, Salvo N, et al. 2012, Vol. 24:112e24.
  5. The NOMS framework: approach to the treatment of spinal metastatic tumors. Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, Bilsky MH. s.l. : Oncologist, 2013, Vols. 18(6):744-51.
  6. NCNN Practice guidelines for Cancer Pain. Ferrel B, Hassenbusch S 3rd, Janjan NA, Lema MJ, Levy MH, Loscalzo MJ, Lynch M, MuircC, Oakes L, O’neill A, Payne R, Syrjala KL, Urba S, Weinstein SM. s.l. : Oncology , 2000, Vols. 14(11A):135-50.
  7. Ablation of skeletal metastases: current status. Kurup AN, Callstrom MR. s.l. : J Vasc Interv Radiol, 2010, Vols. 21(8 Suppl):S242-50.
  8. Combined Ablation and Radiation Therapy of Spinal Metastases: A Greenwood TJ, Wallace A, Friedman MV, Hillen TJ, Robinson CG, Jennings JW. s.l. : Pain Physician, 2015, Vols. 18(6):573-81.