Percutaneous management of metastatic osseous disease

Metastases to the bone represent the third most common site of metastatic disease. More than 50% of patients with metastatic cancer will develop bone metastases. Associated morbidity is related to local tumor progression that destroys bone to result in pain, pathologic fracture, hypercalcemia, and neurologic deficits. Depending on the tumor biology, systemic chemotherapy or radiation therapy may not provide complete local control and may not adequately relieve associated pain. While surgical intervention may be beneficial in many patients, surgical options may also provide incomplete locoregional cure or palliation, and moreover may require extensive healing that can delay systemic therapy. Interventional oncology treatments can provide appealing alternative therapies for osseous metastases. These minimally-invasive therapies can augment existing conventional treatments and even provide a viable option for patients that have exhausted, or are not suitable candidates, for conventional treatments. Interventional oncology treatments are applied for either pain palliation, local tumor control, or both. The goals of treatment can include tumor remission or cure, as well as improved quality of life and mobility. An effective and durable interventional oncology treatment requires a tailored approach that considers the high variability in disease presentation. Osseous metastases may present throughout the skeleton, with low to high vascularity, and undulant to rapidly aggressive tumor biology. This article reviews the main percutaneous treatment for osseous metastases that include embolization, thermal ablation, vertebral augmentation, cementoplasty, and fixation by internal cemented screw (FICS).