Interventionnal Radiology and bone metastases: what options in 2023?

Therapeutic advances in oncology have made it possible to lengthen patient survival in many forms of cancer. Some cancers that had a very short survival have turned into a chronic disease, during which bone metastases may appear, particularly in breast, lung and prostate cancers (80% of bone metastases). The usual therapeutic arsenal involves major analgesics, chemotherapy, radiotherapy, hormone therapy, bisphosphonates, and surgery. These methods can become ineffective, due to major pain caused by various mechanisms (compression of nerve endings, pathological fractures, release of chemical agents, etc.). When there is a painful bone metastasis or at risk of fracture, minimally invasive percutaneous interventional procedures can be performed for analgesic purposes and/or to consolidate the lesion. They are associated with or can replace radiotherapy and/or surgery. They may be performed for curative purposes in oligometastatic patients with small lesions (< 3-4 cm). These bone interventional radiology procedures are classified into consolidation techniques (vertebroplasty, cementoplasty, percutaneous screwing, etc.) and tumor destruction techniques either thermal (heat: radiofrequency, microwave or cold:cryotherapy). They can be combined with each other in a single intervention.