Virolainen Petri, Inoue Nozomu, Nagao Masato, Frassica Frank J, Chao Edmund Y S
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland 21205-2196, USA.
Anticancer Res. 2002 Jul-Aug;22(4):1971-5.
Use of combination adjuvant chemotherapies have improved the disease-free survival rate of tumor patients significantly. Previous experimental studies have shown that chemotherapeutic agents have negative effects on fixation of porous coated prosthesis, but the effects on normal bone turnover rate and mechanicalproperties have been reported to be minimal.
Fourteen dogs were used to study the effect of a doxorubicin, cisplatin and ifosfamide combination in normal bone turnover. We developed a safe and clinically-relevant canine model for multidrug perioperative chemotherapy that simulates current cancer treatment. The bone specimens were analyzed using microradiography, bone histomorphometry and torsional testing. The results were compared with canines that underwent a similar surgical protocol without chemotherapy.
The results showed no differences in mechanical properties after 22 weeks of chemotherapy. The porosity, osteonal activity and mineral apposition rate of the cortical bone were unaffected. The results also showed no difference in porosity of perimeter in cancellous bone, but the mineral apposition rate was significantly reduced.
The difference in mineral appostion rate of cancellous bone shows that, although the effect of temporary chemotherapy on bone may have minor effects on normal turnover and that the effect may be reversible, it causes disturbance in bone mass accumulation. This may later raise the risk for fragility fractures and osteoporosis.
联合辅助化疗的应用显著提高了肿瘤患者的无病生存率。以往的实验研究表明，化疗药物对多孔涂层假体的固定有负面影响，但据报道对正常骨转换率和力学性能的影响极小。
使用14只狗来研究阿霉素、顺铂和异环磷酰胺联合用药对正常骨转换的影响。我们开发了一种安全且与临床相关的犬类多药围手术期化疗模型，该模型模拟了当前的癌症治疗方法。使用显微放射摄影、骨组织形态计量学和扭转试验对骨标本进行分析。将结果与未接受化疗但接受类似手术方案的犬类进行比较。
化疗22周后，力学性能无差异。皮质骨的孔隙率、骨单位活性和矿物质沉积率未受影响。结果还显示，松质骨周边孔隙率无差异，但矿物质沉积率显著降低。
松质骨矿物质沉积率的差异表明，尽管短期化疗对骨骼的影响可能对正常骨转换影响较小且可能是可逆的，但它会导致骨量积累受到干扰。这可能会增加日后发生脆性骨折和骨质疏松症的风险。
