Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

Abstract

Age affects the clinical outcomes of cancer treatment, including those for bone sarcoma. Successful reconstruction using frozen autograft after excision of bone sarcoma has been reported; however, little is known about the clinical outcomes of frozen autograft reconstruction according to age. The purpose was to evaluate the clinical outcomes of the frozen autograft reconstruction focusing on skeletally mature adolescents and young adults (AYAs) that was 15 to 39 years of age. A total of 37 AYA patients with primary bone sarcoma on the appendicular skeleton were enrolled in this study. The mean follow-up period was 89 months. The graft survival (GS), overall survival (OS), recurrence-free survival (RFS), complications and the function were retrospectively evaluated using medical records. The 10-year GS, OS, and RFS rates were 76%, 84%, and 79%, respectively. Bone union was achieved with a rate of 94% within 1 year after surgery, and nonunion (n = 1) and fracture (n = 2) were infrequently observed. Graft removal was performed in 7 cases, and the most common reason for the removal was infection (n = 5). The Musculoskeletal Tumor Society score was excellent in 23 cases of the available 29 cases. Frozen autograft reconstruction for AYAs showed excellent clinical outcomes, although the long-term follow-up is required.

Joint-preservation surgery for bone sarcoma in adolescents and young adults

“…Tumor-devitalized autograft reconstruction is a unique biological procedure involving reimplantation of tumor-bearing bone after the following devitalized treatment: extracorporeal irradiation [45][46][47][48][49][50][51], pasteurization [52][53][54][55][56][57], and freezing [58][59][60][61][62][63][64][65][66]. The advantages of the autograft include a perfect fit to the original site, no risk of viral transmission or immune response problems, easy attachment of capsules, ligaments and tendons, preservation of bone stock, biological stability after graft union, and absence of donor-site morbidity.…”

“… Femur (46), Tibia (14) Humerus (4) OS(79) 82 ± 54 months 83%/5 years Wound complication(6), Nonunion(8), Fracture(2), Implant failure(1), Infection(6) n.a Lee SY, 2018 [ 53 ] Pasteurized 278 24 (5–72) n.a. Femur(137), Tibia(81) Humerus(34) OS(201), ES(11), CS(23) 113 months (25–295) 59%/10 years 40%/20 years Infecction13%, Nonunion7%, Fracture6%, Bone absorption6% n.a Ikuta K, 2018 [ 55 ] Pasteurized 24 22 (5–61) 5 Femur(17), Tibia(1) Humerus(4) OS(20) 88 months (28–208) 70.1%/5 years 70.1%/10 years Nonunion(14), Infection(3), Bone absorption(5), fracture(1) 76% Sugiura H, 2012 [ 54 ] Pasteurized 46 30.7 (10–78) 30 Femur(15), Tibia(10), Humerus(2) OS(17), ES(3), CS(5), 8.7 years (2–17) 94%/10 years Nonunion17%, Fracture15%, Infection13%, Bone absorption13% 83.8% Araki Y, 2021 [ 65 ] Frozen 37 23 (15–39) 37 Femur(20), Tibia(11), Humerus(5), Calcaneus(1) OS(29), ES(3), UPS(3) 89 months (5–229) 86%/5 years, 76%/10 years Infection(7),OA(5), Bone absorption(3), Fracture(2), Nonunion(1), Deformity(1) Excellent 79% Wu PK, 2018 [ 49 …”

“…Fracture was observed in 2 patients who underwent the pedicle freezing procedure, while infection, joint destruction, and fracture were observed in 3, 2, and 1 patient who underwent the free freezing procedure [ 64 ]. Araki et al investigated the clinical outcomes of 37 AYA patients, and reported that bone union was achieved earlier in comparison to older adult patients (8 months vs. 10 months), and that fracture ( n = 2) and nonunion ( n = 1) occurred less frequently in comparison to 27 pediatric patients (fracture, n = 8; nonunion, n = 3) [ 65 ]. Lu et al reported that frozen autograft combined with a vascular fibular graft in 8 patients was associated with earlier bone union (mean period 8.4 months) in comparison to the Capanna technique and that no infection or nonunion occurred.…”

Surgical Site Infection after Bone Tumor Surgery: Risk Factors and New Preventive Techniques

“…The incidence of SSI in total hip arthroplasty was reported as 0.2% [ 13 ], whereas the incidences of SSI in spine surgeries were reported as 3.4–4.2% [ 10 , 12 ]. On the other hand, high incidences of SSI have been reported in patients with malignant bone tumors [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. In patients who underwent megaprosthesis after malignant bone tumor resection, 9.3–20.4% of the patients had SSI [ 14 , 15 ].…”

“…In patients who underwent megaprosthesis after malignant bone tumor resection, 9.3–20.4% of the patients had SSI [ 14 , 15 ]. SSI rates after biological reconstruction were reported as 11.9–13.5% [ 16 , 17 ]. In patients with SSI, additional treatments (such as the long-term administration of antibiotics, implant and grafted bone removal, debridement, irrigation, and reconstruction) are often required.…”