Safety and feasibility of percutaneous vertebroplasty with radioactive 153Sm PMMA in an animal model

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Abstract

Purpose

We investigated the safety and feasibility of the combination of samarium-153-ethylenediamine tetramethylene phosphonate (153Sm-EDTMP)-incorporated bone cement (BC) with percutaneous vertebroplasty (PVP) in dogs.

Methods and materials

153Sm-EDTMP-incorporated BC was prepared by combining solid 153Sm-EDTMP and polymethylmethacrylate (PMMA) immediately before PVP. It was then injected into the vertebrae of four healthy mongrel dogs (two males and two females) by PVP under CT guidance. Each dog was subjected to five PVP sessions at a 153Sm-EDTMP dose of 30–70 mCi. The suppressive effect of local injection of 153Sm-EDTMP on the hematopoietic system was evaluated through counting of peripheral blood cells. Distribution of 153Sm-EDTMP-incorporated BC and the status of tissues adjacent to injected vertebrae were evaluated with SPECT, CT and MRI. Histopathology was carried out to assess the influence of PVP on the vertebra and adjacent tissues at the microscopic level.

Results

PVP was done successfully, and all dogs exhibited normal behavior and stable physical signs after procedures. 153Sm-EDTMP-incorporated BC was concentrated mainly in target vertebrae, and the peripheral blood cells remained within normal range. The spinal cord and tissues around BC did not exhibit signs of injury even when the dosage of 153Sm-EDTMP increased from 30 mCi to 70 mCi.

Conclusion

A dose lower than 70 mCi of 153Sm is safe when it was injected into vertebrae. 153Sm-EDTMP-incorporated BC did not influence the effect of PVP. This means might strengthen anti-tumor activity locally for vertebra with osseous metastasis without damaging adjacent tissues.

Introduction

Percutaneous vertebroplasty (PVP) is used to relieve pain from vertebral compression fractures, hemangiomas, myeloma and metastases [1], [2], [3], [4]. With PVP, pain relief and possible vertebral stabilization can be expected, whereas the development of the metastasis cannot be suppressed due to the limited anti-tumor activity of bone cement (BC). Ethylenediamine tetramethylene phosphonate labeled with samarium-153 (153Sm-EDTMP) is routinely used in the therapy of osteolytic metastasis to relieve pain and retard tumor growth [5], [6], [7]. Systematic administration of a radioactive substance can produce a toxic effect on bone marrow. Local usage of 153Sm-EDTMP may reduce its side effects and enhance its anti-tumor activity on the target metastasis. The combination of BC and 153Sm-EDTMP with PVP may therefore be a promising strategy for the treatment of osteolytic metastases of the vertebral body.

Section snippets

Incorporating 153Sm-EDTMP into BC

Liquid 153Sm-EDTMP (Chendu Gaotong Isotope Company Limited) was infunded in a teat glass and heated on an alcohol burner to evaporate water until solid 153Sm-EDTMP was obtained. Barium sulfate (5 mg) was added into the teat glass before preparation to facilitate observation of solid 153Sm-EDTMP with CT imaging. One gram of polymethylmethacrylate (PMMA) powder was precisely weighed and added into a teat glass containing solid 153Sm-EDTMP. Add 0.5 ml of liquid methylmethacrylate (MMA) into this

Evaluation of changes in behavior and physical signs

The four dogs were raised for 12 months, including the time for five PVP sessions and 8 months of observation after the last PVP. The second day after each PVP procedure, dogs could drink and eat normally, and did not exhibit irritation when the puncture sites were touched or pressed. Physical signs were stable and in the normal range. Blood cell counting results for venous blood drawn 1 month after PVP were within the normal range.

Evaluation of SPECT images

SPECT shown 153Sm-EDTMP accumulated within PVP-treated

Discussion

It has been reported that PVP treatment is effective for 90% of patients with benign diseases; the number fell to 70% for those afflicted with malignancies [8], [9], [10]. We mixed 153Sm-EDTMP into BC to boost the anti-tumor effect of the PVP procedure. Because 22–85 mg of 153Sm-EDTMP was incorporated into 1.38–1.47 g of solid substance, it could be speculated that incorporation of 153Sm-EDTMP may not influence the final strength of polymerized BC. We also sought to minimize the toxic effect of

Conclusion

We have proposed a safe and feasible method by incorporating 153Sm-EDTMP into BC with PVP into the vertebrae of dogs. This means might strengthen the anti-tumor activity locally for vertebra with osseous metastasis without damaging adjacent tissues.

Conflict of interest

There is no any commercial or other interests or associations that might be perceived as posing a conflict of interest or bias in connection with the submitted article.

References (13)

  • I. Resche et al.

    A dose-controlled study of 153Sm-ethylenediaminetetramethylenephosphonate (EDTMP) in the treatment of patients with painful bone metastases

    Eur J Cancer

    (1997)
  • P. Galibert et al.

    Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty

    Neurochirurgie

    (1987)
  • A. Weill et al.

    Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement

    Radiology

    (1996)
  • A. Cotten et al.

    Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up

    Radiology

    (1996)
  • P. Kaemmerlen et al.

    Percutaneous vertebroplasty in the treatment of metastases. Technic and results

    Radiology

    (1989)
  • J.E. Bayouth et al.

    Dosimetry and toxicity of samarium-153-EDTMP administered for bone pain due to skeletal metastases

    J Nucl Med

    (1994)
There are more references available in the full text version of this article.

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