Case 1
A 71-year-old man complainted of persistent pain and braced himself, when coughing. Upon examination, there was pinpoint tenderness over the sternum. On CT scan, there was a lesion measured 5.4 ˣ 4.7 ˣ 3.9 cm in left lung hilum with an osteolytic destruction of the sternal manubrium. The biopsy of lung lesion confirmed squamous cell carcinoma. The patient had a NRS score of 9, and no symptom improvement was obtained with oral narcotic. POP was performed with three needles inserted, and 2.5 ml of PMMA was injected into the sternal lesion (Fig. 1). After the procedure, he gained a significant pain relief, and the NRS scores decreased to 4, 3, 3, and 3, respectively, in follow-up at 1week, 1month, 3month, and 6 month.
Case 2
A 57-year-old woman had a five-year history of right pulmonary adenocarcinoma and treated with neoadjuvant chemotherapy followed by radiotherapy. One month ago, she had severe pain in the anterior chest wall that often affected her sleep. The patient had a NRS score of 8, and the pain was refractory to oral narcotics. CT scan showed multifocal destructive osteolytic lesions of the sternal body and manubrium. POP was performed with three needles inserted and 4.5 ml of PMMA was injected (Fig. 2). After the procedure, she gained pain relief and was able to sleep well, and the NRS scores decreased to 3, 2, 2, and 2, respectively, in follow-up at 1week, 1month, 3month, and 6 month.
Case 3
A 72-year-old man had persistent pain of the anterior chest wall that worsened with body position change. The patient had a NRS score of 8, and the pain was refractory to transdermal narcotic treatment. On CT scan, there was a lesion measured 3.7 ˣ 5.5 ˣ 4.3 cm in left lower lung with an osteolytic destruction of the sternal body. The biopsy of lung lesion confirmed adenocarcinoma. POP was performed with two needles inserted and 1.5 ml of PMMA was injected (Fig. 3). After the procedure, he obtained pain relief, and changing body position didn’t cause pain. His NRS scores decreased to 4, 3, 3, and 3, respectively, in follow-up at 1week, 1month, 3month, and 6 month.
Case 4
A 65-year-old man underwent a thyroidectomy 19 years ago for an undifferentiated carcinoma. He was hospitalized for his anterior chest wall severe pain with NRS score of 9, and no pain relief was gained with transdermal narcotic. His focal anterior chest wall pain corresponded to an osteolytic sternal body metastasis on CT scan. POP was performed through two needles insertion and 2 ml of PMMA injection. The patient achieved pain relief after the procedure (Fig. 4), and the NRS scores decreased to 3, 2, 2, and 2, respectively, in follow-up at 1week, 1month, 3month, and 6 month.