Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients

Hong, Angela; Millington, Scott J.; Ahern, Verity; McCowage, Geoffrey; Boyle, R.; Tattersall, M. H. N.; Haydu, Lauren E.; Stalley, Paul

doi:10.1093/annonc/mdt252

Cited by 61 publications

(64 citation statements)

References 19 publications

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“…Reimplanting the patient's own sterilized tumor bone is one such option which circumvents the logistic issues involved in obtaining size matched strut allografts and obviates the risk of disease transmission. Methods of sterilization have included autoclaving, microwave, pasteurizing, liquid nitrogen, and extracorporeal radiotherapy (ECRT) …”

Section: Introductionmentioning

confidence: 99%

Reconstructing diaphyseal tumors using radiated (50 Gy) autogenous tumor bone graft

Puri

Byregowda

Gulia

et al. 2018

Journal of Surgical Oncology

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Section: Introductionmentioning

confidence: 99%

Reconstructing diaphyseal tumors using radiated (50 Gy) autogenous tumor bone graft

Puri

Byregowda

Gulia

et al. 2018

Journal of Surgical Oncology

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“…They also believed that higher doses were unnecessary, take longer to administer and may increase detrimental effects to bone. Other studies have also conformed this point of view and believe this dose should be sufficient to produce a tumor elimination rate of 100% (23,26). Studies by Sabo et al (27) and Currey et al (28) have demonstrated a radiation dose-dependent reduction in strength and also suggested reduced revascularization and osteoconductive properties, thereby increasing the time to union and incorporation.…”

Section: Discussionmentioning

confidence: 79%

“…Thirdly, this technique also removes the requirement for bone banks and some of the other problems associated with allografts, such as graft rejection and risk of viral transmission (22). Fourth, in pediatric patients, this technique may potentially avoid the growth discrepancy commonly observed in prosthetic replacement by avoiding resection of the normal growth plate and appositional bone growth from surrounding healthy bone (23).…”

Section: Discussionmentioning

confidence: 99%

En bloc resection, intraoperative extracorporeal irradiation and re‑implantation of involved bone for the treatment of limb malignancies

Zhang

Wang

et al. 2017

mol clin onc

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Abstract. Reconstruction of the defect following limb-sparing resection of malignant bone tumors is controversial and extremely challenging. Extracorporeal irradiation (ECI) and re-implantation have been used for limb salvage surgery for patients, with major advantages, including biological reconstruction, ready availability and preservation of bone stock, over replacement with a megaprosthesis. The purpose of the present study was to present our experience and details of all patients treated with this surgery. Between June 2005 and December 2014, we followed-up 23 patients with limb malignancies who were treated with en bloc excision followed by 50-Gy single dose ECI and re-implantation of involved bone segments. All cases were evaluated based on clinical and radiological examinations, complications and Musculoskeletal Tumor Society (MSTS) score. Mean follow-up period was 77.6 months (range, 17-116 months). A total of 17 patients (73.9%) demonstrated no evidence of disease, 5 (21.7%) patients succumbed to the disease and 1 (4.3%) patient was alive with the disease at the final follow-up. Local recurrence occurred in 3 patients (recurrence rate, 13.0%) in the bed outside of the irradiated graft, and 4 of the 5 patients that lost their lives did so due to associated metastatic disease. The mean value of the MSTS score was 78.8% (50-93.3%). The majority of patients demonstrated solid bony union; however, 3 patients had non-union (13.0%) and 1 had a delayed union (4.3%). Early or late complications occurred in 11 patients (47.8%). Although the complication rate (47.8%) and re-operation rate (39.1%) were high, ECI and re-implantation may be a useful and cheap technique following en bloc resection for limb salvage in appropriately selected patients. IntroductionThe current management of musculoskeletal malignancies is limb sparing, and depending on the specific tumor, chemotherapy, surgery and radiotherapy are used in various combinations (1). Surgery is the mainstay of malignant bone tumor treatment with en bloc resection, followed by implantation of autograft, allograft or prosthesis to ensure skeletal continuity (1). Reconstruction, precise fit and stability of the materials are the main challenges to overcome. Different reconstruction methods have different advantages and disadvantages. Aseptic loosening of prosthesis and fracture of the allograft are common problems in clinical practice (2,3).In 1968, Spira and Lubin (4) first reported intra-operative extracorporeal irradiation (ECI) and re-implantation of resected bone as a useful method of limb salvage for malignant bone tumors. However, this method does not have a widespread use according to literature; it has only been used in some cases of osteosarcoma, Ewing sarcoma or chondrosarcoma with minimal lytic destruction or predominantly sclerotic changes (5). The dose of radiation produces a dead autogenous bone graft for re-implantation and reconstruction with correct dimensions. Available results have demonstrated excellent oncological outcomes in terms of loc...

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“…The largest series of pelvic reconstructions using extracorporeally irradiated bone was reported by Hong et al 37 They had 35 patients with a pelvic tumour and a 11% local recurrence rate. No details were given about the type of resection or the functional outcome in these patients.…”

Section: Discussionmentioning

confidence: 99%

The use of extracorporeally irradiated autografts in pelvic reconstruction following tumour resection

Wafa

Grimer

Jeys

et al. 2014

The Bone & Joint Journal

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The aim of this study was to evaluate the functional and oncological outcome of extracorporeally irradiated autografts used to reconstruct the pelvis after a P1/2 internal hemipelvectomy. The study included 18 patients with a primary malignant bone tumour of the pelvis. There were 13 males and five females with a mean age of 24.8 years (8 to 62). Of these, seven had an osteogenic sarcoma, six a Ewing's sarcoma, and five a chondrosarcoma. At a mean follow-up of 51.6 months (4 to 185), nine patients had died with metastatic disease while nine were free from disease. Local recurrence occurred in three patients all of whom eventually died of their disease. Deep infection occurred in three patients and required removal of their graft in two while the third underwent a hindquarter amputation for extensive flap necrosis. The mean Musculoskeletal Tumor Society functional score of the 16 patients who could be followed-up for at least 12 months was 77% (50 to 90). Those 15 patients who completed the Toronto Extremity Salvage Score questionnaire had a mean score of 71% (53 to 85). Extracorporeal irradiation and re-implantation of bone is a valid method of reconstruction after an internal hemipelvectomy. It has an acceptable morbidity and a functional outcome that compares favourably with other available reconstructive techniques.

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Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients

Abstract: This large series of ECI shows an excellent long-term local control. It is a good alternative reconstruction method in selected patients. The overall survival is comparable to other published series.

Cited by 61 publications

References 19 publications

Reconstructing diaphyseal tumors using radiated (50 Gy) autogenous tumor bone graft

Reconstructing diaphyseal tumors using radiated (50 Gy) autogenous tumor bone graft

En bloc resection, intraoperative extracorporeal irradiation and re‑implantation of involved bone for the treatment of limb malignancies

The use of extracorporeally irradiated autografts in pelvic reconstruction following tumour resection

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