Murakami Hideki, Kato Satoshi, Ueda Yasuhiro, Fujimaki Yoshiyasu, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan,
Eur Spine J. 2014 May;23 Suppl 2:222-7. doi: 10.1007/s00586-013-3056-2. Epub 2013 Oct 5.
Distant metastases from thyroid carcinoma are successfully cured if they take up radioiodine ((131)I), are of small size, and located in the lungs. Bone metastases have the worst prognosis because (131)I therapy and external beam radiotherapy are less effective. Our propose here is to report a patient with solitary spinal metastasis and multiple lung metastases from thyroid carcinoma, whose spinal metastasis was treated by total en bloc spondylectomy (TES) enhancing antitumor immunity using frozen tumor-bearing bone for spinal reconstruction.
The patient was a 37-year-old male who had solitary spinal metastasis at T4 and multiple lung metastases from thyroid carcinoma. (131)I therapy for the multiple lung metastases resulted in no effect because the apparent (131)I uptake was observed only in T4 metastasis. We performed a TES of T4 with cryotreatment. After en bloc excision of T4, the excised tumor-bearing vertebra was frozen by liquid nitrogen. In spinal reconstruction, the frozen vertebra was used in a mesh cage inserted into the anterior defect.
After surgery, the thyroglobulin level decreased without any other adjuvant therapy and the serum levels of INF-γ and IL-12 increased. This indicates antitumor immunity was activated. Then, (131)I therapy became effective to the lung metastases causing the tumors to decrease in size and number. Three years after surgery, progression in the lung metastases, other metastasis, and local recurrence have not been observed.
TES with cryotreatment as presented is a novel surgery which can enhance antitumor immunity against other visible or non-visible metastases.
甲状腺癌的远处转移灶若能摄取放射性碘（¹³¹I）、体积较小且位于肺部，则可成功治愈。骨转移的预后最差，因为¹³¹I治疗和外照射放疗效果较差。我们在此报告1例甲状腺癌孤立性脊柱转移和多发肺转移患者，其脊柱转移灶采用整块全脊椎切除术（TES）治疗，并使用含瘤冷冻骨进行脊柱重建以增强抗肿瘤免疫力。
患者为37岁男性，有T4椎体孤立性脊柱转移及甲状腺癌多发肺转移。由于仅在T4转移灶观察到明显的¹³¹I摄取，¹³¹I治疗多发肺转移无效。我们对T4椎体进行了TES并联合冷冻治疗。整块切除T4椎体后，将切除的含瘤椎体用液氮冷冻。在脊柱重建中，将冷冻椎体用于插入前方缺损处的网笼中。
术后，在未进行任何其他辅助治疗的情况下，甲状腺球蛋白水平下降，血清INF-γ和IL-12水平升高。这表明抗肿瘤免疫力被激活。随后，¹³¹I治疗对肺转移灶有效，使肿瘤大小和数量减少。术后3年，未观察到肺转移、其他转移及局部复发进展。
所介绍的联合冷冻治疗的TES是一种新型手术，可增强针对其他可见或不可见转移灶的抗肿瘤免疫力。
