Percutaneous Femoroplasty, Ileoplasty and Sacroplasty in the Treatment of Bone Lytic Lesions in Advanced Multiple Myeloma Patients

Wide experience have been reported on vertebroplasty in multiple myeloma patients. Much less experience is available for the treatment of osteolytic lesions in other critical sites. The aim of this report is to evaluate feasibility, safety and efficacy of transcutaneous femoroplasty, ileoplasty and sacroplasty in advanced multiple myeloma patients with severe osteolytic lesions. From November 2004 to May 2008 8 consecutive advanced myeloma patients (3 males and 5 females, median age 75 years, range 50–78) with pelvis and femora bone lytic lesions entered the study. They received percutaneous bone-cement injection with a solution of 8 to 22 polymethylmethacrylate (PMMA) into supracetabular (4 cases), sacral (2 cases) and femoral bone cavities (2 cases). Lesion approach was performed by 10 g bone biopsy needle under Computed Tomography (CT) and fluoroscopic guidance. In two cases, characterized by large extraosseous lesions, tumour termoablation with radiofrequency was done before PMMA injection. Procedures were performed under local anaesthesia, conscious sedation and antibiotic profilaxis with intravenous ceftriaxone in all patients. Immediate complications were studied with post procedure CT control. Efficacy was evaluated in term of pain relief and mobility recovery. Pain and mobility were assessed by visual analogue scale score (VAS) system (grading 0–10) and functional mobility score system (grading 1–4) respectively (according with “CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases” Radiol med (2008) 113:114–133). Evaluation was performed before and at determined time points after the procedure (at 24 hours, one week, one month and every 3 months). Technical success was achieved in all patients. No complication was recorded. Before the osteoplasty pain assessment by VAS score showed a median value of 6 (range 4–8) and all patients were on analgesic therapy with oppioids and NSAIDs before the procedure. The VAS score decreased to median value 0 (range 0–1.5) within 24 hours after the procedure. The score remained unmodified during the rest of follow-up (median 17.5 months range 2–43). Seven patients were pain free (VAS score 0). Persistence of mild pain was documented in a single patient (score 1,5). Functional mobility score before osteoplasty was 4 in all patients (all were unable to autonomous deambulation). Score became 1 in all (autonomous mobility) within one week after procedure and remained stable during the follow up. Percutaneous osteoplasty is a feasible and safe procedure in patients affected by multiple myeloma with pelvis and femora osteolytic painful lesions. The methylmetacrylate injection is a minimally invasive procedure providing immediate improvement of quality of life. This intervention can contribute to treatment of the multiple myeloma in association with conventional therapy.