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

Abstract

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.

Pasteurized autograft reconstruction after resection of periacetabular malignant bone tumours

“…To obtain adequate hip joint function, the pelvis should be reconstructed as originally as possible to maintain the position of the hip centre of rotation, femur and acetabulum offset, and limb length, to keep an optimal gluteal moment arm [22]. Reconstruction with combined hemipelvic prosthesis could place the acetabulum in the correct position and direction [13]; however, it was difficult to fix the prosthesis in the correct position and direction during the operation, because of the geometrical complexity of the pelvis and large defects in the bone and soft tissue.…”

“…However, the usage of replacement autograft is limited by the quality of the autograft. The structure of the bone should not be visibly destroyed by the tumour [18, 22, 23]. And using pasteurized autograft would cause the lack of material for the overall histologic assessment of the chemotherapy effect.…”

“…For autografting, the replacement of the extracorporeally irradiated [21, 22] or autoclaved [8, 18] tumour-bearing bone has been reported by many authors to be a feasible method for reconstruction after pelvic malignant bone tumour resection. To our knowledge, only a few studies have reported reconstruction with pasteurized autograft for periacetabular malignant bone tumours [23, 24].…”

Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments?

“…35,49 In six patients, reconstruction was performed by reimplantation of the extracorporeally irradiated autograft. The excised bone segment was irradiated with a dose of 90 Gy for about 35 minutes, 42 which was then fixed to the remaining pelvic bones with plates and screws.…”

“…[21][22][23][24][25] While selected cases involving neurovascular structures still require external hemipelvectomy, [25][26][27] limb-salvage through pelvic reconstruction achieves greater postoperative function and quality of life. 28 The reconstructive options include endoprosthetic reconstruction, 23,[29][30][31][32][33][34][35][36][37] biological reconstruction using allograft 38,39 or autograft, [40][41][42][43][44] iliofemoral arthrodesis, 24,45 or hip transposition arthroplasty. 28,46,47 The high complication rate is a major problem of these reconstructive procedures except for hip transposition arthroplasty, which includes superficial/deep infection, dislocation, neurovascular and visceral damage, mechanical and structural failure, and wound dehiscence/necrosis, 24,25,29,32,[48][49][50] and these complications are associated with poor functional outcomes.…”