E2758. Musculoskeletal Oncology Intervention: A Primer for Interventional Radiology Trainees
  1. Max Devine; University of Nebraska Medicine Center
  2. Timothy Donovan; University of Nebraska Medicine Center
  3. Lei Yu; University of Nebraska Medicine Center
Systemic therapies for musculoskeletal (MSK) malignancies have continued to improve. Although this has increased patient lifespan, it has consequently increased the time for MSK metastatic growth and growing needs for MSK oncology interventions. It is essential for interventional radiology trainees to be familiar with fundamental knowledges and technique basics of various imaged guided MSK interventions.

Educational Goals / Teaching Points
After viewing this educational exhibition, the viewers will be familiar with the basics of MSK oncology interventions including different ablation techniques (cryoablation versus radiofrequency ablation), cementoplasty and kyphoplasty, indications, and common complications. In addition, the viewers will be able to identify appropriate patient populations and design individualized treatment plans.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
MSK oncology intervention is categorized into palliative treatment (pain reduction) and curative treatment (local tumor control). Palliative care for MSK malignancy primarily decreases pain associated with metastases and prevents skeletal-related events (SRE). Radiation therapy (RT) remains the standard of care for pain, but percutaneous ablation therapy has been shown to provide significant pain relief in both radiation naive and radiation-refractory metastases. Interventional prevention of SREs is directed at re-establishing structural integrity to skeletal metastases at risk of fracture using techniques like cementoplasty or kyphoplasty. Local tumor control for oligometastatic disease is typically done with surgery or stereotactic body radiotherapy (SBRT). Percutaneous ablation for oligometastatic disease has been shown to provide adequate local tumor control and could postpone the initiation of systemic therapy for MSK oligometastases. We reviewed one case with painful pathologic compression fracture of thoracic spine due to metastatic breast cancer. Radiofrequency ablation was performed for pain control followed by kyphoplasty for structure support. A second case reviewed was oligometastatic iliac bone lesion from cholangiocarcinoma which was treated with combined cryoablation and cementoplasty with curative intent.

MSK oncology interventions have a growing role in multidisciplinary treatment for oncology patients. It is important to provide education and training to more interventional radiologist trainees on various MSK oncology procedures.