Phull Sunjeev S, Yazdi Alireza Rahimnejad, Ghert Michelle, Towler Mark R
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.
J Bone Oncol. 2020 Dec 16;26:100345. doi: 10.1016/j.jbo.2020.100345. eCollection 2021 Feb.
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.
转移性骨病变在晚期癌症患者中很常见。虽然在诊断后可能会立即进行化疗和放疗，但大多数严重的转移性骨病变通过重建手术治疗，在某些情况下，术后还会进行放疗或化疗。然而，尽管骨科手术最近取得了进展，但接受重建手术的患者仍有发生肿瘤复发和重建失败等严重并发症的风险。这导致了聚甲基丙烯酸甲酯和无机骨水泥作为化疗药物（通常是抗肿瘤药物）的局部载体被引入和评估。本研究是对这些骨水泥在骨科肿瘤学中潜在应用的文献的批判性综述。虽然几项研究已经证明了在将全身副作用降至最低的同时提供高局部药物浓度的益处，但仅进行了六项研究来评估这些载药骨水泥的局部毒性作用，并且所有研究都报告了对健康骨结构的负面影响。这些发现并未关上化疗骨水泥的大门；相反，它们应该有助于在设计未来治疗转移性骨病的材料时进行材料选择。
