Bone metastases - minimally invasive treatment
Bone metastases can cause considerable pain, movement limitation and bone fractures.
An innovative minimally invasive procedure “burns” the metastases using heat or cold, and provides significant and immediate relief.
Bone metastases usually come through the bloodstream, from another source of primary cancer, which may be: Lung cancer, kidney cancer, thyroid cancer, prostate cancer, breast cancer, etc. (metastases may occur due to all cancers). The metastasis travels with bloodstream and “settles” in the bone.
The presence of metastasis is considered problematic in itself. When the metastasis settles in the bone, it can cause severe pain, which can lead to a mechanical problem that makes it difficult for the patient to function, to weaken the bone and even to a risk of fracture.
How can bone metastases be treated?
Bone metastases can be treated in a number of ways, such as medicinal therapy, radiotherapy, or extensive surgery. As part of extensive surgery, in order to remove all parts of the bone that was damaged by the tumor, a part of the bone must be removed and then reconstructed.
In recent years, the minimally invasive method has been introduced in Israel to treat bone metastasis. This method eliminates the need for a large and complex surgery and provides many advantages.
What is the minimally invasive procedure for treating bone metastases and how is it performed?
Treatment with the minimally invasive method is done by inserting a needle into the metastasis, which is found inside the bone. Before the surgery, the patient undergoes a series of tests and simulations to understand the location and size of the metastasis.
Avery advanced and sophisticated navigation system called O-Arm, which includes an O-shaped arm, us used in the operation room. The system is based on electro-optics, and therefore it does not use radiation and enables to map the patient`s body very accurately and insert the needle into the lesion at any location in the body.
After insertion into the tumor, the needle performs an action called thermal ablation.
How the ablation of the metastases is done?
The ablation is performed using one of the two techniques:
Insertion of a needle that works on radio waves and warms at its tip up to 90°C. After a few minutes of exposure to the high temperature, the tumor cells become necrotic and do not survive.
The second method is called cryoablation and performed by freezing. The temperature of the needle is decreased to -40°C. In this case too, the low temperature kills the cells and causes their necrosis.
The procedure is performed under sedation because it is only an insertion of a needle and there is no need for a large surgical incision with large exposure of the bone that usually ends with one or two sutures, depending on the size of the lesion.
Can the minimally invasive method completely replace large surgeries?
In some cases the entire bone is already involved and the small, local treatment offered by the minimally invasive method is not applicable.
What are the advantages of the minimally invasive method over extensive surgeries?
There are situations in which the minimally invasive method may prevent significant pain, prolonged recovery time, impaired functioning and risks and/or complications such as secondary infections.
For example, in cases where the metastasis is located in a very problematic area, a very large exposure is required in order to reach it, even if the tumor is sized one or two centimeters only.
With the minimally invasive method, there is no need for a large, complex surgery. In such cases, in the framework of extensive surgery a part of the bone has to be removed and replaced in order to remove the lesion.
Sometimes, these are very large and complex parts, such as part of the pelvis or hip joint that have to be removed and then restored.
This type of surgery requires very extensive exposure that poses risks of infections, complications and long recovery.
The function of the reconstructed part of the bone will never be completely restored.
With the minimally invasive method, surgery is much shorter and involves fewer risks and concerns of complications. The patient’s discharge is much sooner and he immediately returns to his regular activity.
In addition to these advantages, the amount of analgesics taken by the patient decreases significantly and almost immediately.
What are the risks of the minimally invasive method?
In any thermal ablation, there is a risk of burn - thermal burn in case of radiofrequency method or cryogenic burn in case of cryoablation, however, the likelihood of the burns is very low.
Is the minimally invasive method suitable for patients with advanced stages?
Almost any patient may undergo this procedure. Even patients in advanced stages of the disease whose condition does not allow and extensive surgery can undergo a minimally invasive procedure since it is much less stressful and traumatic to the body.
It is important to note that the treatment with this method is palliative and is intended to alleviate the patient’s condition and not cure him from the disease. For the most part, these are conditions in which even an extensive surgery will not lead to full recovery.
In these cases only palliative treatment can be given to reduce the unpleasant symptoms.
In some cases, if it is a single metastasis and the general condition of the patient is very good, a full recovery is possible as well.
However, in most cases, the use of the method is intended to bring great relief to the patient and to improve his daily functioning, and in this he treatment certainly succeeds.
Are there special preparations that the patient must perform before the procedure or instructions he must follow during recovery?
On the contrary, in a minimally invasive surgery unlike in other surgeries, there are no instructions the patient must follow. Of course, before the surgery, the patient will undergo a series of tests and imagings, but the patient does not need to make special preparations besides that, and he will be discharged home the next day and will be able to return to normal life,
What are the success rates of the minimally invasive method?
The procedure can be determined as successful in most people who undergo it.
Postoperative tests and imagings usually indicate that the tumor is gradually disappearing in the surgical area, and patients also report that the pain has decreased.
For example, patients who have a shoulder disability and are unable to move the shoulder to the extent that disrupts their daily functioning and harms their quality of life, return to full function one or two weeks after the procedure.
A metastasis in a bone causes considerable pain and interferes with functioning. A minimally invasive procedure is considered much less invasive and aggressive than surgery.
In the minimally invasive method, there is no damage to the structure of the bone or a change of the joint, but only the treatment of the metastasis itself, instead of breaking down the entire bone and reconstructing it.
This is a significant advantage of the minimally invasive procedure.
It is very important to note that treatment is not a "magic" that can make the disease disappear. This is a metastatic disease, and we should remember that metastases can occur later in other parts of the body.
Sometimes, the same metastasis may recur, after a while.
The minimally invasive method for the treatment of bone metastases provides immediate pain relief, rapid return to full function and effective treatment of bone metastases, all with minimal pain and physical trauma to the patient.
Therefore, a test for eligibility to a minimally invasive procedure is mandatory test for anyone suffering from bone metastases. This is a procedure that can lead to a significant and immediate improvement in the patient`s quality of life.