Advances in personalized treatment of metastatic spine disease

Ahangar, Pouyan; Aziz, Mina; Rosenzweig, Derek H.; Weber, Michael H.

doi:10.21037/atm.2019.04.41

Cited by 22 publications

(19 citation statements)

References 117 publications

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“…Pathological fracture of the spine is caused by tumor invasion of the vertebral body and its appendages, resulting in severe pain in the lower back, spinal dysfunction, neurological dysfunction, and paraplegia, seriously affecting the quality of life [ 2 ]. Traditional surgery or chemoradiotherapy for spinal metastatic cancer causes severe trauma and various complications and has narrow application range and poor efficacy [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

Geng

et al. 2020

BMC Neurol

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Background To investigate the clinical efficacy and safety of bone cement combined with radiofrequency ablation (RFA) in the treatment of spinal metastases. Methods The medical records of patients with spinal metastatic tumor admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed. Based on different surgical methods, the patients were divided into groups A (treated with RFA combined with bone cement) and B (treated with bone cement only). Group A included 35 patients with 47 segments of diseased vertebral bodies. Group B consisted of 52 patients with 78 vertebral segments. Pain, quality of life score, vertebra height, bone cement leakage, postoperative tumor recurrence, and complications were assessed 3 days and 1 and 6 months after surgery. Results All the patients had smooth operation without paraplegia, spinal cord injury, and perioperative death. Visual analogue scales (VAS) and Oswestry Disability Index (ODI) scores of the two groups significantly improved 3 days and 1 month after surgery compared with those before surgery (P < 0.05), but no significant difference was observed between the two groups (P > 0.05). Six months after surgery, the VAS and ODI scores of patients in group A were lower than those in group B, with statistically significant differences (P < 0.05). The postoperative vertebral body height of the two groups significantly increased compared with that before surgery, and the difference was statistically significant (P < 0.05). Meanwhile, no significant difference was observed between the two groups (P > 0.05). Postoperative bone cement permeability in group A was 6.4%, and postoperative tumor recurrence rate was 11.4%. The permeability of bone cement in group B was 20.5%, and the tumor recurrence rate was 30.8%. The bone cement permeability and tumor recurrence rate in group A were lower than those in group B, with statistically significant differences (P < 0.05). Conclusions Bone cement combined with RFA for the treatment of spinal metastases can achieve good efficacy, desirable analgesic effect, low incidence of complications, small surgical trauma, and high safety. The proposed method has the value of clinical popularization and application.

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Section: Introductionmentioning

confidence: 99%

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

Geng

et al. 2020

BMC Neurol

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“…Metallic implants, polyetheretherketone (PEEK) devices and medical acrylic cements are synthetic substitutes typically used to fill/stabilize bone defects or prosthetics where load-bearing is applicable. Limitations of the current treatment options are (1) synthetic substitutes like PMMA comprised of fixed structures often lack osteoconductive/inductive properties and/or (2) bioactive cement pastes (calcium phosphates) promote bone regeneration yet do not possess high structural mechanical strength on their own (Ahangar et al, 2019a). These limitations are particularly concerning in the context of tumor resection and trauma reconstructions in the spine for example.…”

Section: Discussionmentioning

confidence: 99%

A Composite Lactide-Mineral 3D-Printed Scaffold for Bone Repair and Regeneration

Fairag

Ramírez-GarcíaLuna

et al. 2021

Front. Cell Dev. Biol.

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Orthopedic tumor resection, trauma, or degenerative disease surgeries can result in large bone defects and often require bone grafting. However, standard autologous bone grafting has been associated with donor site morbidity and/or limited quantity. As an alternate, allografts with or without metallic or polyether-etherketone have been used as grafting substitutes. However, these may have drawbacks as well, including stress shielding, pseudarthrosis, disease-transmission, and infection. There is therefore a need for alternative bone substitutes, such as the use of mechanically compliant three-dimensional (3D)-printed scaffolds. Several off-the-shelf materials are available for low-cost fused deposition 3D printing such as polylactic acid (PLA) and polycaprolactone (PCL). We have previously described the feasibility of 3D-printed PLA scaffolds to support cell activity and extracellular matrix deposition. In this study, we investigate two medical-grade filaments consistent with specifications found in American Society for Testing and Materials (ASTM) standard for semi-crystalline polylactide polymers for surgical implants, a pure polymer (100M) and a copolymeric material (7415) for their cytocompatibility and suitability in bone tissue engineering. Moreover, we assessed the impact on osteo-inductive properties with the addition of beta-tricalcium phosphate (β-TCP) minerals and assessed their mechanical properties. 100M and 7415 scaffolds with the additive β-TCP demonstrated superior mesenchymal stem cells (MSCs) differentiation detected via increased alkaline phosphatase activity (6-fold and 1.5-fold, respectively) and mineralized matrix deposition (14-fold and 5-fold, respectively) in vitro. Furthermore, we evaluated in vivo compatibility, biosafety and bone repair potential in a rat femur window defect model. 100M+β-TCP implants displayed a positive biosafety profile and showed significantly enhanced new bone formation compared to 100M implants evidenced by μCT (39 versus 25% bone volume/tissue volume ratio) and histological analysis 6 weeks post-implantation. These scaffolds are encouraging composite biomaterials for repairing bone applications with a great potential for clinical translation. Further analyses are required with appropriate evaluation in a larger critical-sized defect animal model with long-term follow-up.

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“…When metastatic tumor forms, tumor cells interact with normal cells in the vicinity, influence their cellular function, and destroy the primary microenvironment (Futakuchi et al., 2016 ; Shupp et al., 2018 ). Bone offers metastatic cells unique microenvironments termed ‘niches’ (Croucher et al., 2016 ; Ahangar et al., 2019 ). The slow blood flow in bone, mechanical property, various chemokines, and growth factors are beneficial to tumor cells’ growth (Zhu et al., 2018 ; Turpin et al., 2020 ).…”

Section: Osteolytic Cancer Bone Metastasismentioning

confidence: 99%

“…Bone metastases occur in about 70% of patients suffering from advanced breast cancer or prostate cancer and approximately 15–30% of patients with carcinoma of the lung, colon, stomach, bladder, uterus, rectum, thyroid, or kidney (Irelli et al., 2016 ; Sun, Han, et al., 2016 ). Escaping from the tumor in-situ , tumor cells enter circulation through blood vessels and lymph vessels and then travel all over the body to find fertile soil to proliferate (Croucher et al., 2016 ; Vinay & KusumDevi, 2016 ; Chen, Pei, et al., 2018 ; Ahangar et al., 2019 ). The special structure and microenvironment of the bone marrow are beneficial for tumor cells to grow (Ahangar et al., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

“…Escaping from the tumor in-situ , tumor cells enter circulation through blood vessels and lymph vessels and then travel all over the body to find fertile soil to proliferate (Croucher et al., 2016 ; Vinay & KusumDevi, 2016 ; Chen, Pei, et al., 2018 ; Ahangar et al., 2019 ). The special structure and microenvironment of the bone marrow are beneficial for tumor cells to grow (Ahangar et al., 2019 ). Tumor cells replicate in the new environment continually, develop into a metastatic tumor, and destroy the bone structure.…”

Section: Introductionmentioning

confidence: 99%

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The optimized drug delivery systems of treating cancer bone metastatic osteolysis with nanomaterials

Cheng

Wei

et al. 2020

Drug Delivery

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Advances in personalized treatment of metastatic spine disease

Cited by 22 publications

References 117 publications

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

A Composite Lactide-Mineral 3D-Printed Scaffold for Bone Repair and Regeneration

The optimized drug delivery systems of treating cancer bone metastatic osteolysis with nanomaterials

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