C3-C5 Chordoma Resection and Reconstruction with a Three-Dimensional Printed Titanium Patient-Specific Implant.
- 作者列表："Parr WCH","Burnard JL","Singh T","McEvoy A","Walsh WR","Mobbs RJ
BACKGROUND:With this case report, we aim to add to the clinical literature on the use of three-dimensional printed patient-specific implants in spinal surgery, show the current state of the art in patient-specific implant device design, present thorough clinical and radiographic outcomes, and discuss the suitability of titanium alloy as an implant material for patients with cancer. CASE DESCRIPTION:A 45-year-old man presented with neck and left arm pain combined with shoulder weakness. Imaging revealed significant destruction of the C3-C5 vertebrae, and chordoma diagnosis was confirmed by biopsy. Gross total tumor resection including multilevel corpectomy was performed in combination with reconstruction using a three-dimensional printed titanium custom implant. Custom-designed features aimed to reduce reconstruction time and result in good clinical and radiographic outcomes. Clinical scores improved postoperatively and remained improved at 17-month postoperative follow-up: visual analog scale score 10/10 preoperatively improved to 2-6/10 at 17 months; Neck Disability Index 46% preoperatively improved to 32% at 17 months. Neither dysphagia nor dysphonia remained after surgical soft tissue swelling subsided. The patient was successfully treated with proton beam therapy after surgery, with no tumor recurrence at 17-month follow-up. Radiographic assessment showed incomplete fusion at 3 months, with clinically insignificant implant subsidence (2.7 mm) and no implant migration or failure at 14 months. CONCLUSIONS:Computer-aided preoperative planning with three-dimensional printed biomodels and custom implant resulted in relatively quick and simple reconstruction after tumor resection, with good clinical and radiographic outcomes at 17 and 14 months, respectively. For patients with primary tumors who may require follow-up radiotherapy or postoperative magnetic resonance imaging, metals used in the devices cause significant imaging artifact.
背景: 通过这份病例报告，我们的目标是在临床文献中增加在脊柱手术中使用三维打印的患者特异性植入物，展示患者特定植入装置设计的最新技术水平，展示彻底的临床和影像学结果，并讨论钛合金作为癌症患者植入材料的适用性。 病例描述: 男性，45 岁，因颈部及左臂疼痛，合并肩部无力就诊。影像学显示C3-C5 椎骨明显破坏，经活检证实为脊索瘤。使用三维打印钛定制植入物进行大体全肿瘤切除 (包括多节段椎体切除术) 联合重建。定制设计的功能旨在减少重建时间，产生良好的临床和影像学结果。术后临床评分改善，17 个月随访时仍有改善: 术前视觉模拟评分 10/10 分，17 个月时改善至 2-6/10 分; 颈部残疾指数 46% 术前改善至 17 个月时的 3 2%。手术软组织肿胀消退后，吞咽困难和发音障碍均未遗留。患者术后成功行质子束治疗，17 个月随访无肿瘤复发。影像学评估显示 3 个月时融合不完全，临床上无明显种植体下沉 (2.7毫米)，14 个月时无种植体迁移或失败。 结论: 计算机辅助术前规划，使用三维打印生物模型和定制植入物，肿瘤切除后重建相对快速和简单，在 17 个月和 14 个月时具有良好的临床和影像学结果，分别。对于可能需要后续放疗或术后磁共振成像的原发性肿瘤患者，器械中使用的金属会导致显著的成像伪影。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.