ALCOHOLIZATION OF OSSEOUS METASTASES
MECHANISMAlcoholization is carried out under scanographic control.The osseous lesion is scanned, thus determining the area of the tumour needing treatment. After being located under the skin, the lesion is punctured, once the cutaneous and subcutaneous layer and the area surrounding the tumour have been locally anaesthetised, with a 20 G needle of lumbar puncture type or 22G Chiba needle. Once the site of the needle has been controlled by TDM, an intratumoral injection of a local anaesthetic (xylocaïne 1 %) and an injection of a iodine tracer product (used to control the spreading of the alcohol), are given. After some TDM control cuts, ethanol to 96 % can be injected. If when it is controlled, the iodine tracer product is absent, this means the needle is in an intravascular position and thus indicates the need to modify its position. If on the contrary the iodine tracer product is leaking towards organs such as the urethra, the sciatic nerve or the rachidian canal, for example, the procedure will be stopped or the needle repositioned.
TECHNIQUEAlcoholization is carried out under scanographic control.The osseous lesion is scanned, thus determining the area of the tumour needing treatment. After being located under the skin, the lesion is punctured, once the cutaneous and subcutaneous layer and the area surrounding the tumour have been locally anaesthetised, with a 20 G needle of lumbar puncture type or 22G Chiba needle. Once the site of the needle has been controlled by TDM, an intratumoral injection of a local anaesthetic (xylocaïne 1 %) and an injection of a iodine tracer product (used to control the spreading of the alcohol), are given. After some TDM control cuts, ethanol to 96 % can be injected. If when it is controlled, the iodine tracer product is absent, this means the needle is in an intravascular position and thus indicates the need to modify its position. If on the contrary the iodine tracer product is leaking towards organs such as the urethra, the sciatic nerve or the rachidian canal, for example, the procedure will be stopped or the needle repositioned.
The quantity of alcohol to be injected
depends on the size of the tumour. In general, for a metastasis of less
than 3-4 cm in diameter, 1,5 to 3 cm3 of ethanol is enough, but for
bulkier lesions, the amount can reach 15 cm3. The alcohol injection is
painful, but an injection of xylocaïne before the injection of the
ethanol attenuates these burns.
It is important to control the good
diffusion of alcohol throughout the lesion. The ethanol is seen in the
form of a negative hypodensity on the scanographic cuts.
In the event of the pains reappearing
or when the antalgic action proves to be incomplete, the procedure can
be repeated after an interval of 2 or 4 weeks.
COMPLICATIONSComplications following alcoholization treatment are extremely rare. The side effect which patients say they suffer from most frequently, is limited to local burns during the first 24 hours. Hyperuricemy and fever are very rare but appear to be linked to a massive post alcoholization tumoral necrosis.Complications leading to neurological deficiency (paraplegia, sciatic nerve) are linked to a lack of precision in the technique and / or use of simple radioscopy.
INDICATIONS AND RESULTSThe indications of tumoral alcoholization are as follows :neurological pains, deficiencies, danger of pathological fractures, danger of immobilization, high amounts of analgesics, failure of conventional treatment. The alcoholization of osseous metastases gives best results with consolidation of pathological fractures and reduction in tumoral pains. To obtain good results, the alcoholization treatment must be repeated. The antalgic effect appears quickly within the two days following the alcoholization treatment. This effect is observed in the majority of the patients and is reinforced and maintained by the repetition of the treatment. The antalgic effect lasts from 10 to 27 weeks. The best results are obtained with tumours between 3 and 6 cm in diameter. A reduction in the size of the tumour is obtained in 25 % of cases. In the majority of the cases, the size of the tumour remains stable (58 %) and in 17 % of the cases, the tumour continues to evolve. On average, bulky metastases require four to six treatments in order to obtain a noticeable antalgic effect. Pathological consolidations of fractures were described after several alcoholization treatments. In In the case of secondary vertebral
localizations, the alcohol injection can be dangerous because of the potential
risk of medullary lesions in the event of the ethanol escaping into the
canals.
CONCLUSIONThe Alcoholization of osseous metastases is a simple technique to put into place and does not take up much space.It is carried out primarily with an antalgic aim. The antalgic effect quickly obtained in the majority of the patients is remarkable and brings a high level of pain relief and comfort. In addition, a reduction in the size of the tumour is possible. Tumoral alcoholization can be largely used in the palliative treatment of the tumours alone or in association with the other therapeutic treatments, thus making it possible to reduce the amounts of conventional analgesics (opiates for example). The simplicity and the harmlessness of the technique allow for its use in out-patient clinics.. In the first 24 hours following treatment, prickling and local burns can occur, but they only rarely require an increase in the quantity of analgesics prescribed for this period. Scanographic control of this treatment allows for optimal precision whilst still not taking up too much space. In addition TDM cuts allow for good observation of the spread of the ethanol. The patients must be systematically followed up and checked every three weeks for a possible renewal of the treatment.
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