Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Abstract

We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At fiveyear follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.

Biological reconstruction after excision, irradiation and reimplantation of diaphyseal tibial tumours using an ipsilateral vascularised fibular graft

“…25 The technique of excision, irradiation and reimplantation has the advantage of being a biological reconstruction with the potential for long-term survival. 26 It is cheap and convenient, but requires the proximity of a radiotherapy department. 27 Only one surgeon is needed and the operating time is much shorter than with the Capanna technique.…”

Extracorporeal irradiation of tumorous calvaria: a case series

“…This technique has been described in the maxillofacial and orthopedic literature for malignant musculoskeletal tumors, where the involved tumorous bone is resected, irradiated extracorporeally, and reimplanted. 3,6,10,11,15,21,25,32 Recently, long-term studies (mean follow-up range of 45-66 months) indicated no local tumor recurrence at the extracorporeally irradiated skeletal bone. 2,3,6,21 Both animal and in vitro human studies directly comparing autoclaving with irradiation indicated a superior biomechanical profile and better incorporation of the reimplanted bone with irradiation.…”

“…3,6,10,11,15,21,25,32 Recently, long-term studies (mean follow-up range of 45-66 months) indicated no local tumor recurrence at the extracorporeally irradiated skeletal bone. 2,3,6,21 Both animal and in vitro human studies directly comparing autoclaving with irradiation indicated a superior biomechanical profile and better incorporation of the reimplanted bone with irradiation. 6,7,24 When cadaveric bone flaps are used for implantation, they are irradiated to extremely high doses in the range of 1000-40,000 Gy to destroy antigens as well as infectious agents.…”

The Effect of Perioperative Radiation Therapy on Spinal Bone Fusion Following Spine Tumor Surgery

“…Emery et al6) reported that long bone fractures after irradiation in laboratory animals are associated with a high pseudarthrosis rate, delayed union, decreased strength and decreased periosteal osteoblastic proliferation, decreased formation of cartilage and osteoid, and decreased vascularity after irradiation. Another study showed that the frequency of delayed unions for extracorporeally irradiated autografts in rats has been related to the irradiation dose19); 16% at 1 kGy, 24% at 5 kGy, and 100% at 25 kGy. Emery et al7) reported that patients who had anterior vertebrectomy and bone strut grafts fusion for spinal neoplasm with irradiation doses greater than 4000 cGy showed increased pseudarthrosis ( p <0.003).…”