Author + information
- Rajeev Bhardwaj1
Treatment of bone tumors is usually surgical. However, surgery may be complex in some tumors. Pre-operative, intra-arterial embolization is developing a method for benign and malignant tumors. The present study was done to assess the outcome on the size of tumor and blood loss by preoperative tumor embolization and pain relief in patients with inoperable tumors.
25 patients with biopsy proven bony tumors of extremities were subjected to embolization. In 12 cases, embolization was done preoperatively to decrease the blood loss. In 13 patients, it was done as a palliative treatment to reduce pain, as patients were inoperable. The embolization was done with right judkin's catheter. Some cases were done with a microcatheter. The material used for embolization was either PVA particles or micro coils, selectively into the feeding vessel.
Mean age of the patients was 44.5 ± 21.4 years. 15 were male and 10 were female. Total 60 vessels were embolized, 25 with gel foam, 24 with PVA particles and 11 with micro coils. In 90% of operated patients gel foam was used, whereas, in almost 100% of non-operated patients, PVA particles were used. There was significant decrease in blood loss in patients with preoperative embolization (1633 ± 660 ml vs 420 ± 420 ml). In patients with palliative embolization, mean pain score before embolization was 6.32 ± 2.58, which was decreased to 3.92 ± 1.93 (P<0.0010), within 6 hours, with further improvement in pain ext two days to a mean score of 3.2 ± 1.53. At follow-up of 6 weeks, out of 13 patients, 4 were lost to follow-up, 4 had a decrease in tumor size, 2 had no change and 3 had an increase in size. At 6 months, 6 were lost to follow-up, one had a decrease in size, 5 had an increase in size and one had no change in size.
Preoperative and palliative transarterial embolization of soft tissue and bony tumors is a safe, effective and minimally invasive modality for pain relief and devascularization of large bony tumors in anatomically difficult locations. It decreases the blood loss significantly when used preoperatively inoperable tumors.