9 Springer-Verlag New York, Inc. 1998 Cardiovasc Intervent Radiol (1998) 21:208-213 CLINICAL INVESTIGATIONS Transcatheter Arterial Embolization for Malignant Osseous and Soft Tissue Sarcomas. I1. Clinical Results Yasushi Nagata, 1 Michihide Mitsumori, 1 Kaoru Okajima, ~ Takashi Mizowaki, ~ Kazuhisa Fujiwara, ~ Keisuke Sasai, ~ Yasumasa Nishimura, 1 Masahiro Hiraoka, ~ Mitsuyuki Abe, 1 Katsuji Shimizu, 2 Yoshihiko Kotoura 2 ~Department of Radiology, Kyoto University Hospital, Sakyo Kyoto 606-8507, Japan 2Department of Orthopedics, Kyoto University Hospital, Sakyo Kyoto 606-8507, Japan Abstract Purpose: To evaluate the clinical effects of transcatheter arterial embolization (TAE) on malignant bone and soft tissue tumors. Methods: TAE was performed in 10 patients with primary bone and soft tissue sarcomas and in 31 patients with met- astatic bone tumors. The embolized arteries were the internal iliac artery in 30 cases, the intercostal artery in six cases, the lumbar artery in five cases, the suprascapular artery in three cases, and the iliolumbar artery, the internal pudendal artery, and the lateral sacral artery in one case each. The embolized material was gelatin sponge particles. The chemotherapeutic drugs were usually 20-40 mg of doxorubicin for primary and metastatic tumors and 50-100 mg of cisplatin only for primary tumors. In addition, 50-60 Gy of 10-MV radiother- apy with or without radiofrequency (RF)-capacitive hyper- thermia in four sessions was administered before TAE for primary tumors only. Results: Even though the pain score increased immediately after TAE, 30 of 38 (79%) patients with pain (8 of 9 with primary tumors, and 22 of 29 with metastases) achieved pain control after TAE. A necrotic low-density area shown by computed tomography (CT) after TAE was found in 31 of 41 (76%) tumors [8 of 10 (80%) with primary tumors, and 23 of 31 (74%) with metastatic tumors]. The tumor size decreased in 14 of 25 (56%) primary and metastatic tumors after 3 months. Osteosclerotic changes appeared in two cases of metastatic tumors after 6 months. In five tumors resected after TAE, large areas of necrosis within the tumor were confirmed histologically. Transient local pain and numbness appeared after TAE, but were relieved by drug treatment within 1 week. No severe complications except a case of Correspondence to: Y. Nagata, M.D. gluteal muscle necrosis were encountered after TAE. The 1-year survival rate of the patients with primary tumors was 38.1%, and the median survival was 18 months. The longest survival was 84 months. The 1-year survival rate of the patients with metastatic bone tumors was 38.9%; the median survival was 12 months. The longest survival was 24 months. Conclusion: TAE could be an effective treatment for pain control and local control of malignant bone and soft-tissue tumors. Key words: Transcatheter arterial embolization--Bone tu- mors-Soft tissue sarcoma--Metastases--Pain control-- Radiotherapy Transcatheter arterial embolization (TAE) is an estab- lished method of treatment for hypervascular tumors such as hepatocellular carcinoma (HCC) [1, 2] and renal cell carcinoma (RCC) [3], as well as a treatment for arterio- venous malformation (AVM) [4-6]. However, in the treatment of bone and soft tissue tumors, TAE has not played an important role to date, despite the fact that extensive bone and soft tissue tumors or refractory osse- ous metastases often cannot be controlled by conventional surgery and/or radiotherapy. This study evaluated the clinical efficacy of TAE for bone and soft tissue sarcomas. For primary tumors, unresectable bone and soft tissue tumors were indicated for TAE as a combination therapy with radiotherapy with or without hyperthermia. For os- seous metastases, refractory or recurrent cases after ra- diotherapy were indicated only for TAE. A mild chemo- therapeutic agent was administered together with TAE.