gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Detection of circulating tumor cells after cement augmentation of vertebral metastases

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  • Sven O. Eicker - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Malte Mohme - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Marc Dreimann - Universitätsklinikum Hamburg-Eppendorf, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Hamburg, Deutschland
  • Stefan Werner - Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
  • Sabine Riethdorf - Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
  • Tobias Gorges - Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
  • Frank W. Floeth - Hospital zum Heiligen Geist Kempen, Zentrum für Wirbelsäulenchirurgie/Neurochirurgie, Kempen, Deutschland
  • Frederic Bludau - Universitätsklinikum Mannheim, Orthopädisch-Unfallchirurgisches Zentrum, Mannheim, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Klaus Pantel - Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
  • Harriet Wikman - Universitätsklinikum Hamburg-Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.26.02

doi: 10.3205/17dgnc332, urn:nbn:de:0183-17dgnc3329

Published: June 9, 2017

© 2017 Eicker et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: Cement augmentation via percutaneous vertebroplasty (VP) or kyphoplasty (KP) for treatment of spinal metastasis is a well-established treatment option. Leakage of the liquid cement out of the vertebral body into the surrounding vessels with subsequent embolization is, however, a wellknown risk of pressure directed injection. We assessed whether elevated intrametastatic pressure during cement augmentation results in an increased dissemination of tumor cells into the vascular circulation. Since circulating tumor cells (CTCs) may have a prognostic value, we further assessed marker expression (cytokeratin; K and HER2) and perioperative frequency.

Patients and methods: In this single-center, prospective study, peripheral blood samples for CTC analyses were obtained from 19 patients with metastatic involvement of the spinal column. The blood was collected on three time points: preoperatively, 20 min post cement augmentation and four days postoperatively. CTC detection was performed using CellSearchTM; an FDA approved automated immunomagnetic CTC detection system.

Results: Up to now, 19 patients were included (6 male and 13 female, mean age 61.1 years, range 45 - 76 years). Histopathological findings of the primary tumors showed breast- (n = 11, 57.9%), lung- (n = 3, 15.8%), colorectal (1), renal- (1), hepatocellular- (1), prostate- (1), and esophagealcarcinoma (1). Cement augmentation was performed in vertebral bodies of the thoracic (n = 12) or lumbar (n = 11) spine. In 7 patients multiple levels were augmented. EpCAM+/CK+ CTCs were detected preoperatively in 17 patients (mean: 26.8 CTCs/7.5ml blood, SD 47.7). 20 min post-surgery a significant increase of CTC was detected (mean: 64.7 CTCs, SD: 55.9, p < 0.05) and on day four the mean CTC count returned to the preoperative level (mean: 20.4, SD: 24.4, p = 0.005).

Conclusions: This is the first study to report that peripheral circulating tumor cells (CTCs) are temporarily significantly increased due to the vertebral cement augmentation procedure. If this CTC dissemination leads to new metastatic seeding or affects the prognosis will be assessed in future studies. Taken together, our findings provide a rationale for the development of new strategies to reduce the increased dissemination of CTC after vertebroplasty. Molecular analysis further gives new insights into CTC heterogeneity and the clonal dynamics involved in dissemination of tumor cells.