Open/Close Menu Medico Chirurgo-Radiologo Interventista Policlinico Universitario Campus Biomedico

RADIOLOGIA INTERVENTISTICA MUSCOLOSCHELETRICA

I trattamenti di radiologia interventistica riducono il dolore e migliorano la qualità di vita nelle metastasi ossee che rappresentano la terza sede di malattia metastatica (1).

La localizzazione delle cellule tumorali a livello dell’osso determina un’erosione dello stesso con assottigliamento ed indebolimento osseo derivante. Ne deriva un’attivazione delle terminazioni nervose all’interno dell’osso e nei tessuti circostanti con generazione del segnale del dolore a livello dell’encefalo. Se non trattate le metastasi comportano una frattura patologica della sede di malattia che riduce ulteriormente la qualità di vita dei pazienti (2).

Il radiologo interventista concorre così con gli altri specialisti (oncologo, radioterapista, chirurgo ortopedico) alla gestione della patologia con finalità non curative ma palliative allo scopo di ridurre il dolore, prevenire la progressione locale di malattia e migliorando la eventuale funzionalità dell’arto coinvolto.

Se parliamo di trattamenti palliativi nel caso delle metastasi si parla oggi invece di terapia risolutiva della radiologia interventistica nel caso di patologie ossee focali benigne quali l’osteoma osteoide mediante trattamenti ablativi quali la radiofrequenza e la crioablazione.

Tali trattamenti ablativi possono essere associati anche a procedure di embolizzazione nel caso di lesioni di grandi dimensioni (> 5cm) allo scopo di ottenere un debulking qualora richiesto dallo specialista oncologo di riferimento.

Inoltre compito del radiologo interventista è anche quello di effettuare un’embolizzazione preoperatoria nel caso di una prevista chirurgia vertebrale per localizzazione di malattia secondaria allo scopo di ridurre il rischio di sanguinamento intraoperatorio ed agevolare la procedura chirurgica.

Oggi il radiologo interventista può effettuare anche la stabilizzazione percutanea con viti di fratture patologiche sotto guida fluoro-TC.

Nel caso di lesioni metastasi vertebrali il radiologo interventista può effettuare un’ablazione diretta della lesione ed effettuare quindi un trattamento di vertebroplastica, procedura quest’ultima che si effettua solitamente nel caso di crolli vertebrali su base osteoporotica.

La tecnica consiste nell’effettuare un approccio diretto percutaneo sotto guida fluoroscopica con o senza TAC a livello della vertebra coinvolta. Un volta raggiunta la vertebra con approccio mono o bipenducolare  viene iniettato cemento nel soma vertebrale con il risultato immediato a poche ore dalla procedura di ridurre drammaticamente il dolore, prevenire ulteriori collassi della vertebra consolidandola e migliorando la qualità di vita del paziente

 

  • Bone Tumor.org
  • Pain from bone metastasis: surgical strategies. The University of Texas M.D. Anderson Cancer Center Web site. Partners in Knowledge, News in Cancer. April 2001.

 

Figure

 

Fig 1

Osteoma Osteoide dell’astragalo trattato con un’unica seduta di RFA di 6 minuti con scomparsa completa dell’edema algodistrofico e del dolore  nel controllo a 1 mese.

Fig 2

Paziente con singola lesione ossea da pregresso tumore del polmone con intensa sintomatologia dolorosa. Crioablazione ecoguidata con 4 criosonde e controllo TC con  immediata riduzione a 24 ore del dolore da 9 a 1 nella scala NRS.

Il successivo Controllo PET dimostra la negatività del quadro con scomparsa della captazione patologica.

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