Extracorporeal Irradiation and Reimplantation of Tumor-bearing Bone Segments Following Diaphyseal Sarcoma Resection at the Tibia

Abstract

Background/Aim: Reconstruction of diaphyseal tibial sarcomas with extracorporeal irradiated autograft is a rarely applied technique and is analyzed in this study. Patients and Methods: Eight patients with malignant sarcomas received local treatment by means of a wide resection and reimplantation of an extracorporeallyirradiated autograft. The graft was combined with an ipsilateral vascularized fibula when a full-thickness segment of the tibia had to be resected and no cortex could be preserved (n=5). Oncological and functional results were recorded. Results: All patients had clear margins after resection, and with no local recurrence 72 months after treatment. Full weight-bearing was allowed at the time of radiological consolidation of the irradiated grafts (after a median of five months). The functional results were good and excellent in 7 of 8 patients, respectively. Conclusion: Extracorporeal irradiation grafting is a suitable method for the treatment of localised and resectable tibial sarcomas. Diaphyseal sarcomas at the tibia are rather rare and sometimes challenging due to the reduced soft tissue coverage, as well as the poor blood supply (1). Common treatment options include wide resection and reconstruction with intercalary endoprostheses, as well as biological strategies such as distraction osteogenesis, the induced membrane technique, or vascularised/non-vascularised bonegrafts (2). 2015 This article is freely accessible online.

Vascularized Bone Graft Reconstruction Following Bone Tumor Resection at a Multidisciplinary Sarcoma Center: Outcome Analysis

“…Complete bony union (<12 months) was observed in 86% (12/14) of patients at the proximal osteotomy sites, after a median (IQR) time of 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) months, and in 64% (9/14) of patients at the distal osteotomy site after a median (IQR) of 6 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) months. Delayed union occurred in one proximal and five distal junctions but healed at a median (IQR) of 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) months. Therefore, the vascularized fibular grafts had achieved overall bony union at a median (IQR) of 6 (4-12) months in 13 out of 14 patients; the remaining was a case of nonunion at the proximal end of the fibular graft.…”

Combination of Extracorporeally-irradiated Autograft and Vascularized Bone Graft for Reconstruction of Malignant Musculoskeletal Tumor

“…Furthermore, reimplantation of the resected bone allows the operator to widely resect the tumor without inconvenience of minding about preservation of bone stock which can be a big issue when reconstructing with prosthesis. Adaptation to the bony defect is anatomically perfect and soft tissue structures such as ligaments and tendons can be reconstructed after the reimplantation of the autograft (20). By combining vascularized bone grafts it can be used for larger bony defects and the rate of adverse events decreases.…”

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…The combined reconstruction with a vascularized fibula and an allograft has the advantages of both previously described techniques [ 31 ]. Furthermore, among the reconstruction techniques which use non-viable bone material, the re-use of resected tumour bone can also be included [ 32 ]. For this purpose, the bone segment must be processed by pasteurization, gamma irradiation, or cryotherapy [ 17 – 19 ].…”