Anti-tumour effects of localized hyperthermia on an experimental bone tumour using an intramedullary nail

Thermal necrosis induced by electrocauterization as a local adjuvant therapy in local aggressive bone tumors, what is the safe limit for surgical margins? An experimental study

OBJECTIVE

In the current study, it was aimed to investigate the temperature change in the cavity wall and pathologic necrosis occurred during cauterization, which was applied at different voltages and time intervals.

MATERIALS AND METHODS

The right tibias of 32 male rabbits were used. Three 2-mm-diameter holes were created on the cortical surface of the tibia using a hand-held drill. Using an electrocautery device, 55 mV was applied for 3 and 5 s and 65 mV was applied for 3 and 5 s. Maximum temperatures at 3 and 6 mm distance from the application site were measured. Biopsy specimens obtained at 3 and 6 mm distance from the application site were evaluated microscopically for bone cell viability and periosteal necrosis.

RESULTS

Thirty-two rabbits were divided into four groups. In all groups, periosteal bone cells located at the region, extending from the application site to 3 mm distance, died. In this region, application of 55 mV for 3 s caused peripheral necrosis. There were significant differences between the four groups in terms of maximum temperatures measured at 3 mm distance from the application site (p = 0.027). On the other hand, no significant differences were noted between the four groups in terms of maximum temperatures measured at 6 mm distance from the application site (p > 0.05).

CONCLUSIONS

Cauterization of the cavity wall in the spray mode at 55 mV for 3 s after tumor resection caused necrosis in the cavity wall, extending from the application site to 3 mm distance.

LEVEL OF EVIDENCE

Experimental animal study, Level II.

Bone targeted bipolar cooled radiofrequency ablation in a VX-2 rabbit femoral carcinoma model

To determine the effect of bipolar cooled radiofrequency ablation (BCRF) on bone and tumour in a lapine pathologic femoral model. Under institutional approval, twelve New Zealand white rabbits received a single femoral injection of VX2 carcinoma cells (day 0). The rabbit femora, (n = 24), were block-randomized into four experimental groups: tumour-bearing radiofrequency ablation (RFA) treated, healthy bone RFA treated, tumour-bearing shams and healthy bone shams (n = 6 per group). 15 min of thermally regulated (65 °C) BCRF was applied at day 14. Pre- and post-treatment MR imaging was performed and repeated at day 28 prior to euthanasia. Histologic evaluation was used to determine treatment effect on tumour and bone tissue. A thirteenth injected rabbit served as a histologic control (no BCRF electrode placement). Large volumes (12.9 ± 5.5 cm(3)) of thermal ablation were achieved. An eight-fold reduction in tumour growth resulted in RFA treated animals compared to tumour-bearing sham controls (p < 0.001). Osteolysis was controlled in the tumour-treated group. Therapeutic effects were best imaged using MR contrast-enhanced SPoiled Gradient Recalled (SPGR) sequences. Osteoclasts and osteoblasts were observed to be sensitive to BCRF but osteocytes were more resilient. A small number of tumour cells within BCRF treated regions appeared viable post treatment. New bone formation was stimulated in the periphery of the targeted BCRF treatment zone. Structurally large VX2 tumour volumes within bone were successfully ablated with BCRF, stimulating new bone formation in the treatment periphery, although viable appearing osteocytes and tumour cells were observed in some treated regions.

A novel hyperthermia treatment for bone metastases using magnetic materials

Patients with bone metastases in the extremities sometimes require surgical intervention to prevent deterioration of quality of life due to a pathological fracture. The use of localized radiotherapy combined with surgical reinforcement has been a gold standard for the treatment of bone metastases. However, radiotherapy sometimes induces soft tissue damage, including muscle induration and joint contracture. Moreover, cancer cells are not always radiosensitive. Hyperthermia has been studied since the 1940s using an experimental animal model to treat various types of advanced cancer, and studies have now reached the stage of clinical application, especially in conjunction with radiotherapy or chemotherapy. Nevertheless, bone metastases have several special properties which discourage oncologists from developing hyperthermic therapeutic strategies. First, the bone is located deep in the body, and has low thermal conductivity due to the thickness of cortical bone and the highly vascularized medulla. To address these issues, we developed new hyperthermic strategies which generate heat using magnetic materials under an alternating electromagnetic field, and started clinical application of this treatment modality. The purpose of this review is to summarize the latest studies on hyperthermic treatment in the field of musculoskeletal tumors, and to introduce the treatment strategy employing our novel hyperthermia approach.

Effects of hyperthermia on heat shock protein expression, alkaline phosphatase activity and proliferation in human osteosarcoma cells

Hyperthermia can be used as a possible adjuvant therapy in treatment of cancer patients. In this study, the direct effect of hyperthermia on osteosarcoma derived cell lines HOS85, MG-63 and SaOS-2 was investigated. Heat shock at 42 degrees C inhibited proliferation significantly in all three cell lines tested. Furthermore a sub-lethal heat shock (42 degrees C, 1 h) decreases alkaline phosphatase activity, the absolute marker for osteoblast-like cells, in all of the three cell lines. Hsp70 was expressed constitutively and was found to be upregulated in a time-dependent manner; by up to 150% in Western blot analysis. The results of this study indicate that heat shock has an inhibitory effect on human osteosarcoma cells. These data suggest that hyperthermia has an anti-tumour effect on cancers of the bone and might, therefore, become an adjuvant treatment option.

Novel hyperthermia for metastatic bone tumors with magnetic materials by generating an alternating electromagnetic field

We have developed a novel hyperthermic treatment modality using magnetic materials for metastatic bone tumors. The purpose of this study is to show the results of novel hyperthermia for metastatic bone tumors. This novel hyperthermic treatment modality was used for 15 patients with 16 metastatic bone lesions. In seven lesions, after curettage of the metastatic lesion followed by reinforcement with a metal intramedullary nail or plate, calcium phosphate cement (CPC) containing powdery Fe3O4 was implanted into the cavity. In one lesion, prosthetic reconstruction was then performed after an intralesional tumor excision. For the remaining eight lesions, metal intramedullary nails were inserted into the affected bone. Hyperthermic therapy was started at 1 week postoperatively. To comparatively evaluate the radiographic results of patients who underwent hyperthermia (HT group), we also assessed eight patients who received a palliative operation without either radiotherapy or hyperthermia (Op group), and 22 patients who received operation in combination with postoperative radiotherapy (Op + RT group). In HT group, all patients had an acceptable limb function with pain relief without any complications. On radiographs, 87, 38, and 91% were, respectively, considered to demonstrate an effective treatment outcome in HT group, Op group, and Op + RT group. The patients in HT group showed a statistically better radiographic outcome than the patients in Op group (P = 0.0042). But when compared between HT group and Op + RT group, there were no significant difference (P = 0.412). This first series of clinical hyperthermia using magnetic materials achieved good local control of metastatic bone lesion.

Mild heat shock induces proliferation, alkaline phosphatase activity, and mineralization in human bone marrow stromal cells and Mg-63 cells in vitro

Bone formation has been shown to be stimulated by local diathermy in vivo; however, the mechanisms involved in this heat-induced osteogenesis are unclear. In this study, we investigated the direct effect of temperature on human bone marrow-derived stromal cells (BMSCs) and the human osteoblast-like, osteosarcoma-derived MG-63 cells in culture conditions. Both cell types were shown to tolerate the transient exposure to mild heat shock conditions (1 h at 39-41 degrees C), and long-term (96 h) exposure at 39 degrees C stimulated DNA synthesis in BMSC but caused growth arrest in MG-63 cells. Furthermore, 1-h exposure to higher temperatures (42.5-45 degrees C) or continuous 96-h exposure to 40 degrees C or 41 degrees C inhibited the proliferation of both BMSCs and MG63 cells. The level of alkaline phosphatase (ALP) in these cells linearly correlated with the increase in temperature, and the ALP expression, either at the basal level or in response to 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], was enhanced after a single 1-h exposure to 42.5 degrees C. In addition, continuous incubation at 39 degrees C or repeated transient exposure to 39/41 degrees C greatly enhanced the ability of BMSCs to form mineralizing nodules. The heat shock protein HSP70, which was expressed constitutively by BMSCs, was found to be up-regulated by hyperthermia (39 degrees C) and down-regulated at 33 degrees C. The expression of HSP70 could be induced in MG-63 cells by both low- and high-temperature conditions. These data suggest that treatment with a mild heat shock induces the proliferation and differentiation of osteoprogenitor cells, and the direct effects of temperature on bone-forming cells might be one of the mechanisms involved in heat-induced bone formation in vivo.

Effects of superparamagnetic iron oxide on radio-frequency-induced temperature distribution: in vitro measurements in polyacrylamide phantoms and in vivo results in a rabbit liver model

PURPOSE

To determine whether contrast medium containing superparamagnetic iron oxide (SPIO) alters radio-frequency (RF)-related temperature distribution in acrylamide phantoms and in an in vivo model.

MATERIALS AND METHODS

In nine acrylamide phantoms with increasing SPIO content, RF was applied with simultaneous measurement of temperature profile along the probe track. Additionally, magnetic resonance imaging-guided RF ablation was performed in the liver of six rabbits after the intravenous administration of SPIO (0.05 mL per kilogram of body weight) 40 minutes prior to ablation (SPIO group) and in another six rabbits without prior SPIO administration (control group). Coagulation diameter was evaluated on the basis of postprocedural imaging and subsequent gross pathologic findings. Statistical analysis was performed with the Student t test.

RESULTS

In the phantoms, progressive increases in iron content resulted in higher temperatures along the RF electrode track (P < .05). In the in vivo model, however, SPIO at physiologic concentrations did not significantly increase the diameter of coagulation on the basis of either postprocedural imaging or subsequent gross pathologic findings. Additionally, no significant differences were seen in other RF-related parameters including impedance, voltage, current, and grounding pad temperature.

CONCLUSION

Administration of SPIO in conjunction with RF ablation of focal liver lesions is feasible and safe, but no significant difference in the extent of induced coagulation can be expected.