Xun-Wei Liu,1,* Zhi-Guo Wang,1,* Peng Jin,1 Li-Li Yu,2 Gang Sun1 

1Department of Radiology, The 960th Hospital of Joint Logistics Support Force of PLA, Jinan, Shandong Province, People’s Republic of China; 2Department of Information, The 960th Hospital of Joint Logistics Support Force of PLA, Jinan, Shandong Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Gang Sun, Department of Radiology, The 960th Hospital of Joint Logistics Support Force of PLA, No. 25, Shifan Road, Jinan, Shandong Province, 250031, People’s Republic of China, Email cjr.sungang@vip.163.com

Background: Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine. It is emerging as one of the most promising procedures for patients with painful bone metastasis who are unsuitable for surgery or who show resistance to radiotherapy and/or analgesic therapies. However, there are only scarce reports regarding osteoplasty in painful sternal metastases.
Subjects and Method: We report four patients with sternal metastases suffered with severe pain of anterior chest wall. The original tumors included lung cancer and thyroid cancer. For the initially pain medication failing, all the four patients received POP procedure under fluoroscopic and cone-beam CT (CBCT) guidance, and obtained satisfying resolution of painful symptoms at 6-month postop follow-up.
Conclusion: POP is a safe and effective treatment for pain caused by metastatic bone tumors in the sternum. In practice, however, percutaneous puncture of pathologic sternal fractures can be a challenge because of the long flat contour and the defacement by lytic tumor of bony landmarks. We find that the use of fluoroscopic and CBCT can facilitate POP for flat bone fractures with displacing the trajectory planning, needle advancement, and cement delivery in time.

Keywords: osteoplasty, bone metastasis, Pain, palliative care, sternum