Intraoperative Extracorporeal Irradiation and Frozen Treatment on Tumor-bearing Autografts Show Equivalent Outcomes for Biologic Reconstruction

Wu, Po Kuei; Chen, Cheng Fong; Cheng, Yu; Tsai, Shi-Chun; Chen, Tain Hsiung; Chen, Wei Ming

doi:10.1007/s11999.0000000000000022

Cited by 50 publications

(66 citation statements)

References 26 publications

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“…e high complication rate of the osteoarticular graft was also reported in the frozen autograft treated with liquid nitrogen. Igarashi et al reported a graft removal rate of 43.7% (7/16) for frozen osteoarticular autograft, which is comparable to or higher than our result [13], while Wu et al reported no difference in union rate, incidence of complications, or graft failure between ECIA and liquid nitrogen-treated autografts [12]. In general, the complication rate for the osteoarticular recycled autograft is quite high.…”

Section: Discussionsupporting

confidence: 74%

“…In the previous study [6,9,11,12,16], the mean ISOLS radiographic evaluation score for ECIA was reported to be 74%-80.5% and it was 66.4% (range, 54.5%-97.9%) in the present study. Compared with the previous study, the lower score in our study is probably because it is limited to osteoarticular grafts.…”

Section: Sarcomasupporting

confidence: 54%

“…In addition, some inherent heterogeneity in terms of chemotherapy and type of internal fixation in our study could affect the incidence of complications and graft survival. e complication rate for ECIA including intercalary, osteoarticular, or composite graft is reported between 12% and 45% [5][6][7][8][9][10][11][12] (Table 4). In this study, which is limited to the osteoarticular extracorporeal irradiated autograft, the rate of complication requiring reoperation was high (45%, 15/33).…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Osteoarticular Extracorporeal Irradiated Autograft for Malignant Bone Tumor

Takenaka

Araki²,

Ueda

et al. 2020

Sarcoma

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Background and Objectives. Osteoarticular extracorporeal irradiated autograft is an alternative operation technique to prosthetic devices or allografts for reconstruction after resection of bone malignancies. The aim of this study is to assess the complications, radiographic changes, and functional outcomes of osteoarticular ECIA. Methods. We retrospectively reviewed 33 patients who underwent osteoarticular ECIA after bone tumor resection from 1988 to 2014. We investigated complications, radiographic changes by the International Society of Limb Salvage graft evaluation criteria, and functional outcomes according to the Musculoskeletal Tumor Society scoring system. Results. Fifteen patients were reoperated upon due to infection (n = 9), protruding fixation implant (n = 4), or fracture of the grafted bone (n = 2). The average radiographic evaluation score was 66.4%, and the median functional score was 23 (77%). The radiographic score for the proximal humerus or proximal tibia was lower than that for the other locations. The functional score was not different among the autograft sites but was related to the radiographic score. Conclusion. Although osteoarticular ECIA is one of the reasonable surgical options for patients with tumors for which reliable prostheses are not available, we do not recommend osteoarticular ECIA as a routine procedure because of high complication rate.

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Section: Discussionsupporting

confidence: 74%

Section: Sarcomasupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Osteoarticular Extracorporeal Irradiated Autograft for Malignant Bone Tumor

Takenaka

Araki²,

Ueda

et al. 2020

Sarcoma

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“…Regarding the other types of recycled autografts, Lee et al 13 reported that the 10‐year survival of pasteurized autografts in 278 patients (mean follow‐up: 113 months) utilizing various types of reimplantation methods was 73%. Wu et al 14 compared clinical outcomes between 79 ECI autografts and 85 frozen treated autografts. They concluded that both types were associated with similar failure rates of 15% and 11% at mean follow‐ups of 82 and 70 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

A long‐term follow‐up study of extracorporeal irradiated autografts in limb salvage surgery for malignant bone and soft tissue tumors: A minimum follow‐up of 10 years after surgery

Outani

Takenaka

Hamada

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The aim of this study is to assess the survival, function, radiographic appearance, and modes of failure of extracorporeal irradiated (ECI) autografts in a long-term setting. Methods:We retrospectively reviewed 87 patients who were treated for bone and soft tissue tumors using ECI autografts between 1988 and 2009. Results:The 56 patients had a minimum follow-up of 10 years, and the median follow-up period was 16.5 years. The reimplantation procedures included 24 osteoarticular grafts, 16 intercalary grafts, 10 autograft-prosthetic composite grafts, and 6 hemicortical grafts. The 15-year graft and event-free survival rates were 76.8% and 47.9%, respectively. Infection and structural failure were the most common reasons for additional surgery. The time for additional surgery was significantly longer in patients with composite grafts (P < .01). The median Musculoskeletal Tumor Society score and the International Society of Limb Salvage score were 80% and 84%, respectively.Conclusions: ECI autografts are a durable option for reconstruction after resection of musculoskeletal tumors and provide good function over more than 15 years. Most graft failures occurred within 5 years of the index surgery. However, composite grafts showed a tendency to fail more than 10 years after the surgery. K E Y W O R D S autografts, autologous, limb salvage, reimplantation

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“…Reimplantation of the patient's own bone as an autograft after inactivation by using autoclave, 30 , 31 extracorporeal irradiation, 32 , 33 alcohol, 34 and liquid nitrogen 33 , 35 , 36 has been described. Harvest of the autograft, including iliac crest or a free fibula, may be an option.…”

Section: Surgical Considerationsmentioning

confidence: 99%

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

2020

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Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.

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Intraoperative Extracorporeal Irradiation and Frozen Treatment on Tumor-bearing Autografts Show Equivalent Outcomes for Biologic Reconstruction

Abstract: III, therapeutic study.

Cited by 50 publications

References 26 publications

Clinical Outcomes of Osteoarticular Extracorporeal Irradiated Autograft for Malignant Bone Tumor

Clinical Outcomes of Osteoarticular Extracorporeal Irradiated Autograft for Malignant Bone Tumor

A long‐term follow‐up study of extracorporeal irradiated autografts in limb salvage surgery for malignant bone and soft tissue tumors: A minimum follow‐up of 10 years after surgery

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

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