Primary tumors known to metastasize to the pelvis include breast, lung, kidney, prostate, and colon. Pelvic lytic lesions are often associated with severe pain and functional disability (standing, walking). Traditional treatment options are limited to radiation therapy, surgery and cordotomy.
Surgery is the treatment of choice when there are no contraindications, such as location of lytic lesions. Other contraindications include existing medical disorders, prior surgical treatment to the same lytic area, and the treatment of sacral metastases. The benefits of surgery must also be weighed against any adverse consequences of surgery and life expectancy.
Radiation therapy typically provides partial or total pain relief after completion of the treatment. Unfortunately, it can take up to 24 months after radiation treatment for bone remodeling. The remodeling often results in minimal bone strengthening that precludes standing or walking in those with extensive lytic lesions or no bone restoration in those with a short life expectancy. In addition, osteoporosis can precede bone remodeling leading to an increased risk for a pathologic fracture.
Cervical spine cordotomy is performed as either an open surgical or percutaneous radiofrequency procedure to provide pain relief from pelvic metastases. This is accomplished by destroying the sacral fibers of the spinothalamic tract at the C1-C2 cord area. There is a significant risk of morbidity and rare mortality with these procedures. They typically only provide temporary pain relief (approximately one year), are indicated for unilateral pain and do not have any impact on bone strength.
Osteoplasty is a percutaneous procedure for the treatment of painful lytic bone metastases. Methylmethacrylate, bone cement, is injected into the lytic lesions through a large bore size needle under fluoroscopy or CT guidance. Osteoplasty is a safe and effective palliative technique for the treatment of pelvic metastases with a very low complication rate and can be repeated if there is a reoccurence of metastases. Osteoplasty allows for immediate pain relief as well as instant restoration of function (standing, walking) secondary to the pain relief and bone strengthening from the cement injection into the lytic lesions.
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