Regenerative therapy after cancer: what are the risks?

Abstract

There is often a pressing need for reconstruction after cancer surgery. Regenerative therapy holds the promise of more natural and esthetic functional tissue. In the case of breast reconstruction postmastectomy, volume retention problems associated with autologous fat transfer could be ameliorated by augmentation with cells capable mediating rapid vascularization of the graft. Intentional placement of regenerating tissue at the site of tumor resection raises questions concerning the possibility of promoting cancer recurrence. Here we review coculture and animal models of tumor/mesenchymal stem cell interactions under regenerating conditions. Available evidence from case reports, cell lines, and clinical isolates favors the interpretation that regenerating tissue promotes the growth of active, high-grade tumor. In contrast, dormant cancer cells do not appear to be activated by the complex signals accompanying wound healing and tissue regeneration, suggesting that engineered tissue reconstruction should be deferred until cancer remission has been firmly established.

FIG. 1.

Working hypothesis of the interaction between regenerating tissue and an epithelial cancer. The effect of adipose-derived stem cell administration on active breast cancer is depicted here. Introduction of ASC, which self-replicate and give rise to adipose, vessels, and stroma, promotes the growth of active tumor (purple) and induces motility and upregulation of adhesion molecules, promoting invasion and metastasis (deep purple). Dormant cancer cells, shown here nested in a normal breast duct (hot pink, inset), are unaffected by the wound healing signals resulting from regenerative therapy. ASC, adipose-derived stem cells. Color images available online at www.liebertonline.com/ten.