Circulating Tumour Cell Release after Cement Augmentation of Vertebral Metastases

Abstract

Cement augmentation via percutaneous vertebroplasty or kyphoplasty for treatment of spinal metastasis is a well-established treatment option. We assessed whether elevated intrametastatic pressure during cement augmentation results in an increased dissemination of tumour cells into the vascular circulation. We prospectively collected blood from patients with osteolytic spinal column metastases and analysed the prevalence of circulating tumour cells (CTCs) at three time-points: preoperatively, 20 minutes after cement augmentation, and 3–5 days postoperatively. Enrolling 21 patients, including 13 breast- (61.9%), 5 lung- (23.8%), and one (4.8%) colorectal-, renal-, and prostate-carcinoma patient each, we demonstrate a significant 1.8-fold increase of EpCAM+/K+ CTCs in samples taken 20 minutes post-cement augmentation (P < 0.0001). Despite increased mechanical CTC dissemination due to cement augmentation, follow-up blood draws demonstrated that no long-term increase of CTCs was present. Array-CGH analysis revealed a specific profile of the CTC collected 20 minutes after cement augmentation. This is the first study to report that peripheral CTCs are temporarily increased due to vertebral cement augmentation procedures. Our findings provide a rationale for the development of new prophylactic strategies to reduce the increased release of CTC after cement augmentation of osteolytic spinal metastases.

Percutaneous restoration of bone continuity with screws and PMMA cement in an extensive destruction of the pelvis

“…The intervention we report, and especially the injection of cement into the tumor mass without prior tumor ablation, may have induced dissemination of tumor cells into the blood stream. Mohme et al reported a temporary increase in the number of circulating tumor cells in the peripheral blood 20 min after vertebroplasty or balloon kyphoplasty [16]. However, whether this increase affects the survival of patients with bone metastases is unknown.…”

“…However, whether this increase affects the survival of patients with bone metastases is unknown. Also, we do not know whether adding pre-operative radiation or ablation techniques, such as radiofrequency and cryotherapy, could reduce the seeding of viable tumor cells and are valuable treatment options despite their own complications and cost [16].…”

Percutaneous Vertebroplasty of malignant lesions of the thoracolumbar spine: analysis of treatment results

“…However Cruz et al describe first two case of tumor extravasation after VP [25]. Moreover study of Mohme et al indicated an increased dissemination of tumour cells into the vascular circulation after VP [26]. However available literature is lacking in discussion of risk of developing bone metastases after VP.…”

İskelet metastazlarında minimal invaziv tedaviler

“…Bu veri, söz konusu girişim öncesi canlı tümör hücresi yayılımını azaltmaya yönelik stratejilerin (ameliyat öncesi RT, RFA, ameliyat esnasında RT gibi) önemini ortaya koymaktadır. [14] Perkütan sementoplasti, vertebrada popüler bir uygulama olmakla birlikte, pelvis (sıklıkla asetabulum) ve uzun kemiklerde de başarılı sonuçlar elde edilmektedir. [15] Uzun kemiklerde tek başına çimento uygulanması kırık gelişimine engel olmayacağı için, yöntemin metalik implant ile kombine edilmesi gereklidir.…”