1. 2016;19;E767-E773CT-Guided Percutaneous Femoroplasty (PFP) for the Treatment of Proximal Femoral Metastases
   Retrospective Study
   Helin Feng, MD, Jin Wang, MM, Peng Guo, MM, Jianfa Xu, MM, Wei Chen, MD, and Yingze Zhang, MD.

BACKGROUND: The spine, pelvis, skull, and femur are the most common sites of bone metastases, and pain is the main symptom of metastatic tumors. Percutaneous femoroplasty (PFP) is becoming increasingly popular for treating proximal femoral metastases.

OBJECTIVES: To assess the clinical value and feasibility of PFP performed under the guidance of computed tomography (CT).

STUDY DESIGN: A retrospective clinical review comparing pain intensity and the ability to perform activities of daily living before and after treatment with PFP.

SETTING: Single academic medical center.

METHODS: Sixteen patients with proximal femoral metastasis were treated with PFP under CT guidance and followed up for 6 – 12 months. Pain intensity was evaluated using the visual analog scale (VAS) and patients’ quality of life was evaluated using the Barthel Index of Activities of Daily Living (BIADL) preoperatively and at both 7 days and 6 months after PFP.

RESULTS: The mean VAS score decreased from 7.44 ± 0.81 preoperatively to 2.69 ± 0.79 at 7 days postoperatively and 1.25 ± 0.93 at 6 months postoperatively. The BIADL score increased from 44.06 ± 9.53 preoperatively to 69.06 ± 8.61 at 7 days postoperatively and 83.13 ± 6.55 at 6 months postoperatively. No patients suffered from pulmonary embolism or complications such as pathologic fracture of the proximal femur. The median overall survival was 12 months. One patient experienced cement leakage into the hip, and the injection was immediately stopped. Then dexamethasone was injected intravenously to prevent potential pulmonary fat embolism caused by localized high pressure.

LIMITATIONS: The study evaluated a single group of patients before and after CT-guided PFP and did not include a comparison with conventional fluoroscopic approaches in a large patient sample.

CONCLUSION: Use of CT-guided PFP was associated with a low risk of complications and improvement in patients’ quality of life. CT guidance made the operation easy and safe, and thus, this approach represents a potential treatment option for proximal femoral metastases if indications are observed closely.