Clinical StudySystemic antitumor immune response following reconstruction using frozen autografts for total en bloc spondylectomy
Introduction
Total en bloc spondylectomy (TES) is a radical surgery designed to achieve complete resection of an aggressive benign spinal tumor or a malignant spinal tumor, including spinal metastasis, in addition to providing an adequate tumor margin [1]. This procedure has been reported to decrease the rate of local recurrence because local radical cure is achieved [2], [3]. However, it is questionable whether local control prolongs a patient's survival.
In cryosurgery, antitumor immunity is activated after percutaneous cryoablation of the tumor, such as in breast cancer, prostate cancer, renal cell carcinoma, and hepatocellular carcinoma [4], [5]. It has been reported that the metastatic lesions decreased in size or the metastases disappeared because of the cryoimmunological effect after cryosurgery [6]. We applied this tumor-induced cryoimmunology to TES surgery. We have developed a “second-generation TES” that brings about TES enhancing antitumor immunity; this provides promise of improving the patient's life prognosis. Our purpose was to evaluate the immunity-enhancing effect after implementing second-generation TES.
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Study patients
We performed 65 cases of second-generation TES applied tumor-induced cryoimmunology from May 2010 to January 2013. We performed a retrospective review of prospectively collected data in the 65 patients (33 males and 32 females). The average follow-up period for the 65 patients was 22 months (range 5–37 months). The mean age at surgery for these patients was 53.3 years (range 16–75 years).
Of the 65 cases, 57 involved metastatic tumors and 8 involved primary tumors. Of the 57 patients with a
Results
IFN-γ increased after surgery in 45 (75%) of 60 patients. Evaluating all 60 patients, the mean IFN-γ relative concentrations at both 1 and 3 months after surgery, as compared with before surgery, were significantly higher (284%±596% and 275%±354%: p<.05) (Fig. 2). In the series of 27 patients without subcutaneous implantation of the tumor tissue, the mean IFN-γ relative concentrations at both 1 and 3 months after surgery, as compared with before surgery, were higher (409%±852% and 336%±450%:
Discussion
In second-generation TES, instead of harvesting autograft from the iliac crest or fibula, the resected lamina and vertebral body from TES are frozen using liquid nitrogen and used as grafted bone for spinal anterior reconstruction. Although we use tumor-bearing vertebra as grafted bone, the tumor cells are completely killed by being placed into liquid nitrogen for 20 minutes. Tsuchiya et al. [7] already reported on bone reconstruction for malignant tumors in the extremities and pelvis being
Acknowledgments
The authors thank William C. Hutton, DSc, for his kind criticism and advice.
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2019, Journal of Bone OncologyCitation Excerpt :Tumor antigens remaining in autogenous graft might be recognized by T-lymphocytes and then play a role of immune surveillance [27]. Murakami et al. used frozen tumor-bearing autograft inside a cage for reconstruction in total En bloc spondylectomy, and found increased antitumor immunity at post-operative follow up [28]. The present study was unable to demonstrate whether bone maturity status affects the reconstruction failure rate.
Risk factors for local recurrence after total en bloc spondylectomy for metastatic spinal tumors: A retrospective study
2018, Journal of Orthopaedic ScienceCitation Excerpt :Murakami et al. developed the frozen autograft TES method in 2010, which reduces surgical stress [3]. This procedure is less invasive than the conventional surgical approach, because the resected tumor-bearing vertebra is frozen and recycled for anterior column support, thus obviating the need to harvest an autograft from the iliac crest or fibula [4]. Although the objective of frozen autograft TES is to achieve reliable local control, local recurrence has been observed in certain cases.
Biological Reconstruction Using Frozen Autograft in Total En Bloc Spondylectomy for Spinal Tumors
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Author disclosures: HM: Grant: Medical Research Encouragement Prize given by the Japan Medical Association (C); Japanese Foundation for Multidisciplinary Treatment of Cancer (C); Princess Takamatsu Cancer Research Fund (11-24316) (C); Astellas Foundation for Research on Metabolic Disorders (C). SD: Nothing to disclose. SK: Nothing to disclose. KY: Nothing to disclose. HH: Nothing to disclose. KI: Nothing to disclose. TO: Nothing to disclose. KS: Nothing to disclose. NY: Nothing to disclose. XF: Nothing to disclose. HT: Nothing to disclose.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.