The median preoperative carcinoembryonic antigen (CEA) level was 14.4ng/dL. Median survival was 30 months. Recurrent liver disease developed in 78% of patients, with 82% of these recurrences in the liver. Complication rates were comparable to liver resection and operative mortality was 3.7%. This led http://www.selleckchem.com/products/brefeldin-a.html the authors to conclude that hepatic cryoablation is effective and safe in treating colorectal hepatic metastases under image guidance [49]. Cryoablation has also been used to palliate primary and metastatic bone lesions. Callstrom and colleagues prospectively assessed pain outcomes in 14 patients with osseous metastases from various tumors treated with cryoablation. Posttreatment scores for pain relief, worst pain, pain interference with daily activities, and narcotic medication use decreased with the use of cryoablation [50].

Advantages of cryoablation include the large ablation zone potential using multiple probes and ease of visualizing the ��iceball�� with CT guidance. Tuncali et al. reported complete and partial relief of pain in 6 of 19 and 11 of 19 patients with bone and soft tissue tumors, respectively, with a mean diameter of 5.2cm [51]. 3.3. Cementoplasty Cementoplasty refers to the percutaneous injection of polymethylmethacrylate (PMMA) to mechanically stabilize the skeletal system and provide pain relief in patients with osteolytic bony metastases. This stabilization prevents further collapse and relieves pain by mitigating stress on each vertebral body treated. Cementoplasty includes procedures such as vertebroplasty, kyphoplasty, sacroplasty, and osteoplasty, and is typically performed by trained interventional radiologists and surgeons [48].

The process of cementoplasty may be performed under general anesthesia or local anesthesia with conscious sedation or occasionally general anesthesia. A small incision is made, and, under image guidance with fluoroscopy, CT, or less commonly MRI, a trocar or needle is passed into the affected bone. Several commercially available cement preparations of PMMA, such as barium sulfate or tantalum, are mixed with materials to enhance radio-opacity, thereby allowing for better visualization and safer delivery with fluoroscopy. Evaluation of cement filling and potential leakage is also done through real-time imaging with fluoroscopy or CT-fluoroscopy (Figures 4(a)-4(b)).

Adverse effects of the procedure itself include, but are not limited to, transient radicular pain, bleeding, infection, recurrent or adjacent level fracture, and rarely symptomatic pulmonary embolus [48]. Despite these risks, clinically significant complications remain very low in the literature. Figure 4 Plasmacytoma of L2 (a) treated Entinostat with vertebroplasty (b). Cementoplasty has been proven to be effective in pain relief in published reports [52�C54]. Kelekis and colleagues reviewed 14 inoperable patients with painful bony metastases refractory to pain medications and radiation therapy.