
<b>"Reduction of pain without systematic side effects can be achieved in advanced stages of cancer with precise percutaneous techniques guided with computed tomography (CT).</b> CT guidance allows exact needle positioning, reducing complications and improving the results. Regional analgesia ...is achieved by injection of alcohol or phenol and involves intentional destruction of a nerve or nerves to interrupt pathways for weeks or months. Percutaneous alcoholization of bone metastasis is indicated ... if conventional anticancer therapy is ineffective .... Bone packing with acrylic glue (methyl methacrylate) is used to prevent pathologic fractures and pain in patients with vertebral body tumors and acetabular metastasis." [42]

<b>"Percutaneous injection of methylmethacrylate or ethanol may provide marked pain relief or bone strengthening in patients with malignant acetabular osteolyses who are unable to tolerate surgery.  Injection of methylmethacrylate is usually indicated when osteolysis involves the weight-bearing part of the acetabulum ... in all other cases, ethanol injection is preferred. Ethanol and methylmethacrylate injections may be performed together if both weight-bearing and nonweight-bearing parts of the acetabulum are involved or extensive soft-tissue involvement is present. Moreover, these injections may be performed prior to radiation therapy, which complements their action</b> due to similar but delayed effects on pain, or after radiation therapy that failed to relieve pain, or in cases of local recurrence." [17] 

"Radiography and computed tomography must be performed prior to therapeutic percutaneous injection to assess the location and extent of the lytic process, the presence of cortical destruction or fracture, and the presence of soft-tissue involvement. Fever and transitory worsening in pain may occur secondary to inflammatory reaction in the hours following injection; however, these side effects usually resolve spontaneously within 1-3 days. The decision to perform therapeutic percutaneous injections should be made by a multidisciplinary team because the choice between this option and alternative methods of treatment depends on several factors including the location of the lesion, the local and general extent of the disease, the pain and functional disability experienced by the patient, and the patient's state of health and life expectancy." [17] Potential complications include vertebral collapse and infection. [16] Percutaneous intralesional alcohol injections are generally successful and safe. [16, 65, 69]

"Micro-invasive CT-guided intratumoral therapy (MIC-ITT) when used in combination with sympathectomy [destruction of the nerves near the tumor] can be an excellent palliative treatment with little impairment. ... Rapid as well as complete reduction of pain without systemic side effects can be achieved under local anesthesia in patients in advanced tumor stages by the direct instillation of 50 to 96% alcohol and/or a locally efficacious low toxic cytostatic (Mitoxantron) under CT guidance. CT enables not only exact puncture without injuring endangered structures but also a controlled application of medication. ..."[1]
"Repeated micro invasive intratumoral treatment was performed ... In all patients conventional therapeutic strategies had been exhausted or were no longer applicable ... Treatment was performed in combination with sympathetic neurolysis at the upper tumor pole in all cases."   Pain reduction of 75% or more was achieved in 80+% of patients.  <b>For patients with bone and soft tissue mets, a reduction in tumor size was shown in 25%, no change in 62% and progression in 13%.  For those with vertebral metastases, a reduction in tumor size (<50%) in 18%, no change in tumor size in 66%, and progression in 16% of the patients. Furthermore, necrotic zones could be shown in 27%, and recalcification of tumor area in 35%.  "All treatments were free of complications." [1]
"On the whole the results of therapeutic approach are encouraging. In particular one aspect should be mentioned: with respect to palliative treatment the reduction of tumor size is not crucial. The decisive factor is the improvement in quality of life of the patient using an intervention which impairs the patient only minimally. Furthermore this micro invasive approach should always involve the combination of local tumor treatment with treatment or lysis of the autonomic sympathetic nervous system in tumor vicinity." [1]</b>

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