| Part 1. The Anti-tumor Effect of PMMA Bone Cement on Vertebral Tumor of Rabbit after Percutaneous Puncture InjectionObject: To investigate the anti-tumor effect and it's duration of PMMA bone cement on vertebral tumor of rabbit after percutaneous injection.Materials and methods: 1. Establishing vertebral tumor models: New Zealand white rabbits were transplanted with VX2 carcinoma in the lumbar vertebral body with CT guiding percutaneous puncture technique. Vertebral tumor models were checked after 2 weeks by PET-CT. Then the value of SUVmax and SUVmean of each tumor vertebra was measured. 2. Experimental grouping and treatment method: The tumor models were randomly divided into 2 groups. Each group consisted of 15 rabbits. With CT-guided percutaneous puncture technique, 0.3ml PMMA (group A as therapy group), or 0.3ml physiological saline (group B as control group) was respectively injected into the tumor. Five rabbits were randomly taken to be checked again by PET-CT at 1st day, 4th day and 7th day after operation respectively in each group, and the value of SUVmax and SUVmean of each vertebral tumor was measured again. Then the rabbits were executed and the tissues of tumor were collected for pathological examination. 3. Observation index:①The change of the value of SUV: The value of SUVmax and SUVmean of each vertebral tumor in different group and different time was measured and recorded.②HE stain results: The morphological change and necrosis of tumor cells near and away from the bone cements were observed by HE stain.③The result of TUNEL apoptosis measurement: TUNEL apoptosis measurement was used to detect apoptosis of tumor cells near and away from the bone cements, and the apoptosis index (AI) was calculated. 4. Statistic methods: The value of SUVmax and SUVmean of each tumor vertebra before and after PVP was analyzed by Repeated Measures Analysis of Variance. The value of SUVmax and SUVmean of each tumor vertebra in different group and different time was analyzed by Analysis of Factorial. The AI in different group and different time and different place were analyzed by Analysis of Factorial.Results: 1.PET-CT results: The value of the SUV of the tumor vertebra in the PMMA group had statistical difference (P<0.05) among before, 1st day, 4th day and 7th day after treatment, the value of the SUV of the tumor vertebra dropped markedly, at the 1st day, the data was the lowest one, then it rised gradually, and at the 7th day, the value of SUVmean hadn't statistical difference. But the value of the SUV of the tumor vertebra in the pseudo-therapy group increased gradually among 1st day, 4th day and 7th day after treatment, and had statistical difference compared to the value before treatment. In different time after treatment, the value of the SUV of the tumor vertebra in the PMMA group compared to physiological saline group had statistical difference (P<0.05). 2.HE stain results suggested that there was typical necrosis of tumor cells near the PMMA bone cement at 1st day after treatment, and a few tumor cells could be found in necrosis tissues, Far away from the PMMA cement we can found partial necrosis of tumor. At 4th day after treatment, partial necrosis tumor cells can also be seen near the PMMA bone cement, while only a little necrosis tumor cells were found away from it. At 7th day after treatment, only single necrotic cells scattered in the tumor. Significant necrosis of tumor cells was not found in pseudo-therapy group in different time. 3.TUNEL apoptosis examine showed that the Apoptotic index (AI) between different experimental groups, different parts of the tumor, as well as different time after injection with a statistical difference compare to the pseudo-therapy group (P <0.05). The apoptosis of tumor cells near the PMMA cement was significant at 1st day and 4th day after treatment, the apoptosis of partial tumor cells away from the PMMA cement could also be seen. But at 7th day after treatment, the apoptosis of tumor cells either near or far from the PMMA cement was rare. The apoptosis of a few scattered tumor cells of the physiological saline group was visible in each time.Conclusion: PMMA cement could significantly lead to necrosis of the vertebral tumor cells in-vivo and induce apoptosis of the tumor cells. The anti-tumor effect of the tumor cells near the PMMA cement was more significant than that of away from the PMMA cement. The anti-tumor effect gradually diminished with the time after treatment, and was invalid at 7th day, the anti-tumor effect was invalid.Part 2. The Clinical Efficacy of PVP to Treat Osteolytic Vertebral Metastatic Lesions and Its Evaluation By PET-CTObject: To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) for osteolytic vertebral metastatic lesion, and the change about the tumor metabolic activity before and after treatment.Methods: Four patients with painful osteolytic vertebral metastatic lesions were treated by PVP for 5 times in all. All patients were checked by PET-CT to measure the value of SUVmax and SUVmean of each tumor vertebra before treatment, then treated by PVP under fluoroscopic guidance. After (13±0.7) days, PET-CT were taken again and obtained the value of SUVmax and SUVmean from the patients in order to compare with the value before PVP, The patients were asked to quantify the extent of the pain on a visual analogue scale (VAS) before and (13±0.7) days after treatment. Results: Four patients were treated in our institution for 5 times in all, and showed immediate pain alleviation after the procedure each time. No clinically significant complications or unwanted side effects of the cement injection occurred. One week after treatment, the average scor of VAS dropped to (1.8±0.8) compared to pre-operate's (8.0±0.7), and 3 month after PVP, the score of VAS was only (2.8±2.4). In this group, 1 case suffered recurrence of pain, whose preoperative VAS score was 8 points, and it dropped to 3 points initially after treatment, then it rose to 7 points 3 months later, after the 2nd PVP, it returned to 1 point.Conclusion: PVP can reduce vertebral tumor metabolic activity significantly in the treatment of patients'osteolytic vertebral metastatic lesions, and the recent analgesic effect is satisfactory. |
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