Сryoablation technology for bone metastases

摘要

Puncture cryoablation of tumor lesions was performed as a part of complex palliative treatment of 32 patients with the fourth stage of the disease with bone metastases. Each patient, depending on the extent of the lesion, underwent from one to eight procedures. New domestic nitrogen equipment with reusable instruments was used. Cryoablation procedures were performed in the room for Computed Tomography (CT) using robotic navigation, as well as in the operating room under ultrasound monitoring. The indications for the procedure were severe pain syndrome, disease progression, prevention of pathological fractures, and the impossibility of performing the surgical treatment in patients with comorbidities. When performing cryoablation, the number and diameter of cryoprobes, the length of the needle and cryoprobe tip, the direction of insertion, and their mutual positioning were determined depending on the size and shape of the tumor lesion. The technique of puncture approaches and monitoring rules are described in detail. It is recommended to avoid the destruction of the pelvic ring, hip joint, to be careful in cases of tumor localization in the body and arches of the vertebrae, in the lateral parts of the sacrum, in the places where the nerve trunks adhere to the bone. The cryoablation procedure cannot be planned if the skin, the wall of a hollow organ, and the spinal cord are involved in the tumor process. There is a high risk of fracture after performing total cryoablation of metastasis if it covers more than a third of the diameter of the tubular bone.