Minimally Invasive Treatment Strategies for Metastatic Disease of the Skeleton: Current Concepts.

purpose of reviewWith recent advances in systemic cancer treatment, the number of patients with metastatic disease to the skeleton have drastically increased. Patients are now living longer with metastatic disease, leading to a rise in skeletal lesions requiring intervention due to symptomatology, compromised structural integrity with concern for impending fracture, or both. In this review, we discuss current interventional oncology techniques in the treatment of metastatic disease to the skeleton, focusing on advancements in the fields of interventional radiology and orthopedic surgery. RECENT

findingsMultidisciplinary teams now possess vast armamentariums of minimally invasive treatment modalities to address metastatic disease of the skeleton for both palliative and tumoricidal effect. Vascular control is achieved with transarterial embolization, halving intraoperative blood loss in hypervascular lesions. Ablation techniques such as radiofrequency, microwave, cryoablation, high-intensity focused ultrasound, and chemical consistently reduce pain scores and provide local tumoricidal effects with low complication rates. Cementoplasty, percutaneous fixation, and photodynamic bone stabilization reinforce affected bone to prevent or treat fractures, Finally, hybrid approaches, including ablation, osteoplasty, reinforcement, and internal fixation combine minimally invasive options and successfully promote tumor control, alleviate pain, and provide stability, with low morbidity. Current evidence supports a paradigm shift from open surgery toward minimally invasive, image-guided interventions for metastatic skeletal disease. When tailored to lesion biology, anatomical location, and patient goals, these techniques deliver durable palliation, mechanical stability, and local tumor control with fewer risks, making them first-line considerations for many patients with metastatic involvement of the skeleton.