Massive Bone Allograft Reconstruction in High-Grade Osteosarcoma

Donati, Davide María; Liddo, Michele Di; Zavatta, Marcello; Manfrini, Marco; Bacci, Gaetano; Picci, Piero; Capanna, Rodolfo; Mercuri, Mario

doi:10.1097/00003086-200008000-00025

Cited by 190 publications

(165 citation statements)

References 12 publications

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“…The rate of non-union and delayed union corresponded with other reports of ECI autografting of the limb (6,10,16,25,26), and were lower than those observed with reconstructions using allografts (22,30,31). Union occurred faster at the metaphyseal than at the diaphyseal junction in some cases; however, statistical tests were not performed to determine whether these differences were significant.…”

Section: Discussionsupporting

confidence: 76%

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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Section: Discussionsupporting

confidence: 76%

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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“…Intercalary allografts allow attachment of soft tissues and come in various sizes, but patients are subject to a longer period of postoperative immobilization to protect the reconstruction until graft union [20]. They are also associated with complications, including nonunion (18%-64%) [12,15,22,23], fracture of the allograft (15%-51%) [5,12,23,25], and a risk of infection of up to 30% [12,15,26]. In these studies of intercalary allografts, most patients were treated for primary bone sarcomas and are not directly comparable to the majority of patients in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Segmental resection of the diaphysis of a long bone allows preservation of joint function and in skeletally immature patients allows for preservation of the physes. Many surgical options for the resection, reconstruction, and stabilization of segmental intercalary defects have been described and include the biologic options of autografts [7,8,29], allografts [5,6,11,12,15,22,23,25,26], and distraction osteogenesis [13,36] or use of metal constructs including segmental intercalary endoprostheses [9,10,31] and, although less practical, custom implants [1,2,4,18,24,33]. There have been few reports that analyze functional outcomes after treatment with modular segmental intercalary endoprostheses.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Benevenia

Kirchner

Patterson

et al. 2016

Clinical Orthopaedics &Amp; Related Research

101

120

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Background Resection of diaphyseal bone tumors for local tumor control and stabilization often results in an intercalary skeletal defect and presents a reconstructive challenge for orthopaedic surgeons. Although many options for reconstruction have been described, relatively few studies report on the functional outcomes and complications of patients treated with modular intercalary endoprostheses. Questions/purposes The objectives of this study were to examine clinical outcomes after reconstruction with a modular intercalary endoprosthesis with a specific focus on (1) the rate of complication or failure; (2) differences in complication rates by anatomic site; (3) functional results as assessed by the Musculoskeletal Tumor Society System (MSTS); and (4) differences in complication rate between patients treated with cemented versus noncemented fixation. Methods We conducted a retrospective chart review of patients treated with a modular intercalary endoprosthesis from three musculoskeletal oncology centers from 2008 to 2013. The indication for use of this intercalary endoprosthesis was segmental bone loss from aggressive or malignant tumor with sparing of the joint above and below and deemed unsuitable for biologic reconstruction. No other implant was used for this indication during this period. During this period, 41 patients received a total of 44 intercalary implants, which included 18 (40%) humeri, 5 (11%) tibiae, and 21 (48%) femora. There were 27 (66%) men and 14 (34%) women with a mean age of 63 years (range, 18-91 years). Eight patients (20%) had primary bone tumors and 33 (80%) had metastatic lesions. Thirtyfive (85%) patients were being operated on as an initial treatment and six (15%) for revision of a previous reconstruction. Twenty-nine (66%) procedures had cemented stem fixation and 15 (34%) were treated with noncemented fixation. The overall mean followup was 14 months (range, 1-51 months). Patients with primary tumors had a mean followup of 19 months (range, 4-48 months) and patients One or more of the authors (JB) has received funding from the Musculoskeletal Transplant Foundation and has also received fees from Merete Inc (Berlin, Germany) and Implant Cast (Buxtehude, Germany) outside of the submitted work and holds several patents and licensing fees with CreOsso LLC (Montclair, NJ, USA with metastatic disease had a mean followup of 11 months (range, 1-51 months). Causes of implant failure were categorized according to Henderson et al. [19] into five types as follows: Type I (soft tissue failure), Type II (aseptic loosening), Type III (structural failure), Type IV (infection), and Type V (tumor progression). At 2 years of followup, 38 (93%) of these patients were accounted for with three (7%) lost to followup. MSTS functional assessment was available for 39 of 41 patients (95%). Results At latest followup of these 41 patients, 14 (34%) patients were dead of disease, two patients (5%) dead of other causes, seven (17%) are continuously disease-free, one (2%) shows no evidence of disease, a...

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“…There are a number of techniques available for femoral reconstruction of diaphyseal defects following excision of bone tumors. These include the use of autogenous vascularized fibular grafts (9,10), segmental allografts (11)(12)(13), autogenous extracorporeally irradiated bone (14,15), distraction osteogenesis (16,17) and custom-made intercalary endoprostheses (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Custom-made intercalary endoprosthetic reconstruction for a parosteal osteosarcoma of the femoral diaphysis: A case report

Zhao

Zhang

2015

Oncology Letters

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Abstract. The present report describes a case of a 44-year-old female patient who presented with a palpable mass of the left thigh. A diagnosis of parosteal osteosarcoma (POS) at the femoral diaphysis was made following a diagnostic workup. Previous reports of long bone diaphyseal POS are rare. A long diaphyseal segment of the femur containing the tumor was resected along with a healthy margin of soft tissues, and the damaged bone was reconstructed with a custom-made intercalary endoprosthesis. Subsequent pathological examination of the surgical sample confirmed the diagnosis of POS. No local recurrence or distant metastasis was observed, and the patient had a positive Musculoskeletal Tumor Society score of 28/30 (93.3%) at the 28-month post-surgery follow-up. The present study describes the clinical, radiological, and pathological features of this rare type of osteosarcoma.

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Massive Bone Allograft Reconstruction in High-Grade Osteosarcoma

Cited by 190 publications

References 12 publications

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

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

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Custom-made intercalary endoprosthetic reconstruction for a parosteal osteosarcoma of the femoral diaphysis: A case report

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