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Alfonso M, Llombart R, Gil L, Martinez I, Rodríguez C, Álvarez L, Gallego J. Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:480-486. [PMID: 37084999 DOI: 10.1016/j.recot.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8-1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.
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Affiliation(s)
- M Alfonso
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España.
| | - R Llombart
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España
| | - L Gil
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España
| | - I Martinez
- Departamento de Cirugía Ortopédica y Traumatología. Clínica Universidad de Navarra, Pamplona, España
| | - C Rodríguez
- Neurorradiologia Intervencionista. Grupo Quirón Hospitales, Madrid, España
| | - L Álvarez
- Departamento de Cirugía Ortopédica y Traumatología. Fundación Jiménez Díaz, Madrid, España
| | - J Gallego
- Departamento de Cirugía Ortopédica y Traumatología. Fundación Jiménez Díaz, Madrid, España
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Alfonso M, Llombart R, Gil L, Martinez I, Rodríguez C, Álvarez L, Gallego J. [Translated article] Tumor ablation and vertebral augmentation in the treatment of vertebral metastases: A multicenter study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S480-S486. [PMID: 37541348 DOI: 10.1016/j.recot.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/16/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Treatment of metastatic vertebral fractures without neural compression is performed with percutaneous cementation techniques. The increase in intratumoral pressure by these techniques can send tumor cells into the bloodstream. To prevent this dissemination and improve pain treatment, ablation techniques have been introduced that would allow the creation of a cavity in the tumor prior to cementation or directly necrosing the metastasis when its size is small. MATERIAL We present the experience with ablation of two hospitals and two different ablation techniques. The first group used radiofrequency ablation (A) in 14 patients (26 vertebrae), 4 of whom underwent vertebral arthrodesis. The second group used microwave ablation (B) in 93 patients (129 lesions) without associated vertebral instrumentation. RESULTS In group A pain improvement in VAS was 7.7-2.6 at 6 weeks. There were no complications derived from the ablation. In most cases cementation was associated. In the group B pain improvement in VAS went from 6.8 to 1.7 at 6 weeks. Cementation was associated in all cases. There were no complications derived from the ablation. CONCLUSION The association of ablation techniques with vertebral cementation is a safe technique that significantly improves the patient's pain and can help control the disease.
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Affiliation(s)
- M Alfonso
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain.
| | - R Llombart
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - L Gil
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - I Martinez
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - C Rodríguez
- Neurorradiologia Intervencionista, Grupo Quirón Hospitales, Madrid, Spain
| | - L Álvarez
- Departamento de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain
| | - J Gallego
- Departamento de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain
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Chiang JB, Yee DKH. A Toolbox of Bone Consolidation for the Interventional Radiologist. Cardiovasc Intervent Radiol 2023; 46:1447-1457. [PMID: 37165213 DOI: 10.1007/s00270-023-03445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
Bone consolidation is increasingly used in the treatment of both benign and malignant bone conditions. Percutaneous vertebroplasty, for example, has been shown to be useful in vertebral compression fractures in the VAPOUR trial which showed its superiority to placebo for pain reduction in the treatment of acute vertebral compressive fractures. Further tools have since been developed, such as kyphoplasty, spinal implants, and even developments in bone cements itself in attempt to improve outcome, such as chemotherapy-loaded cement or cement replacements such as radio-opaque silicon polymer. More importantly, bone fixation and its combination with cement have been increasingly performed to improve outcome. Interventional radiologists must first know the tools available, before they can best plan for their patients. This review article will focus on the tool box available for the modern interventional radiologist.
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Affiliation(s)
- Jeanie Betsy Chiang
- Block K Department of Radiology and Imaging, Queen Elizabeth Hospital, 30 Gascoigne Road, Yau Ma Tei, Kowloon, Hong Kong SAR, China.
| | - Dennis King Hang Yee
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S, Wang Z, Wu M. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. J Mater Chem B 2023; 11:9369-9385. [PMID: 37712890 DOI: 10.1039/d3tb01494k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.
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Affiliation(s)
- Bo Chao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Jianhang Jiao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Lili Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Yang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Tong Yu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Han Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Mufeng Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Wenjie Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Xiangran Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Shangyu Du
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
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González AS, Llombart-Blanco R, Angulo MG, Tomé CV, Olmos-García MA. Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs. Global Spine J 2023; 13:156-163. [PMID: 33601909 PMCID: PMC9837504 DOI: 10.1177/2192568221994800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Animal experimental model. OBJECTIVE To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. METHODS We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. RESULTS The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. CONCLUSIONS Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.
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Affiliation(s)
- Alvaro Silva González
- Department of Orthopedic Surgery,
University of Navarra, Pamplona, Spain,Department of Orthopedic Surgery, German
Clinic of Santiago, Universidad del Desarrollo, Chile
| | - Rafael Llombart-Blanco
- Department of Orthopedic Surgery,
University of Navarra, Pamplona, Spain,Rafael Llombart Blanco, Department of
Orthopedic Surgery, Clínica Universidad de Navarra, Avd. Pio XII 36, 31008
Pamplona, Navarra 31006, Spain.
| | | | - Carlos Villas Tomé
- Department of Orthopedic Surgery,
University of Navarra, Pamplona, Spain
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Wang Z, Nogueira LP, Haugen HJ, Van Der Geest ICM, de Almeida Rodrigues PC, Janssen D, Bitter T, van den Beucken JJ, Leeuwenburgh SCG. Dual-functional porous and cisplatin-loaded polymethylmethacrylate cement for reconstruction of load-bearing bone defect kills bone tumor cells. Bioact Mater 2022; 15:120-130. [PMID: 35386344 PMCID: PMC8941180 DOI: 10.1016/j.bioactmat.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/13/2022] Open
Abstract
Malignant bone tumors are usually treated by resection of tumor tissue followed by filling of the bone defect with bone graft substitutes. Polymethylmethacrylate (PMMA) cement is the most commonly used bone substitute in clinical orthopedics in view of its reliability. However, the dense nature of PMMA renders this biomaterial unsuitable for local delivery of chemotherapeutic drugs to limit the recurrence of bone tumors. Here, we introduce porosity into PMMA cement by adding carboxymethylcellulose (CMC) to facilitate such local delivery of chemotherapeutic drugs, while retaining sufficient mechanical properties for bone reconstruction in load-bearing sites. Our results show that the mechanical strength of PMMA-based cements gradually decreases with increasing CMC content. Upon incorporation of ≥3% CMC, the PMMA-based cements released up to 18% of the loaded cisplatin, in contrast to cements containing lower amounts of CMC which only released less than 2% of the cisplatin over 28 days. This release of cisplatin efficiently killed osteosarcoma cells in vitro and the fraction of dead cells increased to 91.3% at day 7, which confirms the retained chemotherapeutic activity of released cisplatin from these PMMA-based cements. Additionally, tibias filled with PMMA-based cements containing up to 3% of CMC exhibit comparable compressive strengths as compared to intact tibias. In conclusion, we demonstrate that PMMA cements can be rendered therapeutically active by introducing porosity using CMC to allow for release of cisplatin without compromising mechanical properties beyond critical levels. As such, these data suggest that our dual-functional PMMA-based cements represent a viable treatment option for filling bone defects after bone tumor resection in load-bearing sites. Dual-functional porous PMMA cements are developed by introducing CMC as both pore generator and drug vehicle for cisplatin. PMMA-based cements containing ≥3% CMC release sufficient amounts of chemotherapeutically active cisplatin. PMMA-based cements containing ≤3% CMC retain sufficient mechanical properties for bone reconstruction at load-bearing sites.
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Affiliation(s)
- Zhule Wang
- Radboud University Medical Center, Department of Dentistry - Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Liebert Parreiras Nogueira
- University of Oslo, Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, Oslo, Norway
| | - Håvard Jostein Haugen
- University of Oslo, Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, Oslo, Norway
| | - Ingrid CM. Van Der Geest
- Radboud University Medical Center, Department of Orthopedics, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Dennis Janssen
- Radboud University Medical Center, Department of Orthopedics, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Thom Bitter
- Radboud University Medical Center, Department of Orthopedics, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Jeroen J.J.P. van den Beucken
- Radboud University Medical Center, Department of Dentistry - Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Sander CG. Leeuwenburgh
- Radboud University Medical Center, Department of Dentistry - Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
- Corresponding author. Dept. of Dentistry - Regenerative Biomaterials (309), Radboudumc. Philips van Leydenlaan 25, 6525EX, Nijmegen, the Netherlands. http://www.regenerative-biomaterials.nl
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Cyphert EL, Kanagasegar N, Zhang N, Learn GD, von Recum HA. PMMA Bone Cement Composite Functions as an Adjuvant Chemotherapeutic Platform for Localized and Multi-Window Release During Bone Reconstruction. Macromol Biosci 2022; 22:e2100415. [PMID: 35113499 DOI: 10.1002/mabi.202100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/06/2022] [Indexed: 11/10/2022]
Abstract
Primary bone tumor resections often result in critical size defects, which then necessitate challenging clinical management approaches to reconstruct. One such intervention is the Masquelet technique, in which poly(methyl methacrylate) (PMMA) bone cement is placed as a spacer temporarily while adjuvant chemotherapeutics are administered systemically. The spacer is later removed and replaced with bone autograft. Local recurrence remains an important and devastating problem, therefore, a system capable of locally delivering chemotherapeutics would present unique advantages. In this work, a refillable chemotherapeutic (doxorubicin, DOX) delivery platform comprised of PMMA bone cement and insoluble γ-cyclodextrin (γ-CD) polymeric microparticles is developed and explored towards application as a temporary adjuvant chemotherapeutic spacer. The system is characterized for porosity, mechanical strength, DOX filling and refilling capacity, elution kinetics, and cytotoxicity. Since residual chemotherapeutics could adversely impact bone healing, it is important that virtually all DOX be released from material. Composites containing 15wt% γ-CD microparticles demonstrate 100% DOX release within 100 days, whereas only 6% DOX is liberated from PMMA with free DOX over same period. Refillable properties of PMMA composite system may find utility for customizing dosing regimens. Findings suggest that PMMA composites could have potential as chemotherapeutic delivery platforms to assist in bone reconstruction. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erika L Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Nithya Kanagasegar
- School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
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Phull SS, Yazdi AR, Ghert M, Towler MR. Bone cement as a local chemotherapeutic drug delivery carrier in orthopedic oncology: A review. J Bone Oncol 2021; 26:100345. [PMID: 33552885 PMCID: PMC7856326 DOI: 10.1016/j.jbo.2020.100345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Metastatic bone lesions are common among patients with advanced cancers. While chemotherapy and radiotherapy may be prescribed immediately after diagnosis, the majority of severe metastatic bone lesions are treated by reconstructive surgery, which, in some cases, is followed by postoperative radiotherapy or chemotherapy. However, despite recent advancements in orthopedic surgery, patients undergoing reconstruction still have the risk of developing severe complications such as tumor recurrence and reconstruction failure. This has led to the introduction and evaluation of poly (methyl methacrylate) and inorganic bone cements as local carriers for chemotherapeutic drugs (usually, antineoplastic drugs (ANPDs)). The present work is a critical review of the literature on the potential use of these cements in orthopedic oncology. While several studies have demonstrated the benefits of providing high local drug concentrations while minimizing systemic side effects, only six studies have been conducted to assess the local toxic effect of these drug-loaded cements and they all reported negative effects on healthy bone structure. These findings do not close the door on chemotherapeutic bone cements; rather, they should assist in materials selection when designing future materials for the treatment of metastatic bone disease.
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Affiliation(s)
- Sunjeev S. Phull
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
| | - Alireza Rahimnejad Yazdi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton L8V 5C2, Ontario, Canada
| | - Mark R. Towler
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
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Bickels J, Campanacci DA. Local Adjuvant Substances Following Curettage of Bone Tumors. J Bone Joint Surg Am 2020; 102:164-174. [PMID: 31613863 DOI: 10.2106/jbjs.19.00470] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, The Technion, Israel
| | - Domenico A Campanacci
- Unit of Orthopaedic Oncology, Department of Health Sciences, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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Pountos I, Giannoudis PV. Drug-eluting implants for the suppression of metastatic bone disease: current insights. Expert Rev Med Devices 2018; 15:301-311. [PMID: 29561689 DOI: 10.1080/17434440.2018.1456336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The fixation of impending or pathologic fractures is challenging and their successful management can have a favourable impact on the quality of life of the patient. The progression of the metastatic bone disease can cause significant pain and disability but also could result in the loosening and subsequent failure of the implants. To prevent the additional local growth, postoperative radiotherapy is often recommended, and many patients receive endocrine or chemotherapy. AREAS COVERED Several reports support the antineoplastic drugs to bone cement as an adjuvant to improve implant stability as well as to prevent local cancer progression and failure of reconstructive devices used to treat patients with pathologic fractures. The aim of the present review is to present our current understanding on the effect of local delivery of antineoplastic drugs at the bone site. EXPERT COMMENTARY Encouraging evidence support the application of bone cement loaded with antineoplastic drugs to fill defects and strengthen the fixation of orthopaedic implants. This is an inexpensive and safe method that can improve implant stability, prevent local cancer progression and failure of reconstructive devices. To fully evaluate its clinical effectiveness randomized clinical studies are needed.
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Affiliation(s)
- Ippokratis Pountos
- a Academic Department of Trauma & Orthopaedics, School of Medicine , University of Leeds , Leeds , UK
| | - Peter V Giannoudis
- a Academic Department of Trauma & Orthopaedics, School of Medicine , University of Leeds , Leeds , UK
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Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies. Cardiovasc Intervent Radiol 2017; 40:1815-1823. [DOI: 10.1007/s00270-017-1779-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022]
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