Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty

Abstract

Autogenous bone graft which has been either autoclaved or irradiated is commonly used in oriental countries as an alternative to allograft. We started to use the technique of extracorporeal irradiation of the resected specimen and reimplantation (ECIR) in 1991. There was, however, a high incidence of fracture of the irradiated bone and loss of articular cartilage. In an attempt to reduce these complications, we combined the irradiated autograft with a conventional arthroplasty. Between 1995 and 1998, 14 patients underwent limb salvage by this method. Seven had an osteosarcoma, two bony metastases, three a chondrosarcoma, one a malignant fibrous histiocytoma, and one a leiomyosarcoma. Ten tumours were located in the proximal femur, two in the proximal humerus, and two in the distal femur. One patient who had a solitary metastasis in the proximal part of the left femur died from lung metastases 13 months after operation. The remaining 13 patients were alive and without evidence of local recurrence or distant metastases at a mean follow-up of 43 months (28 to 72). Postoperative palsy of the sciatic nerve occurred in one patient, but no complications such as wound infection, fracture, or nonunion were seen. All host-irradiated bone junctions healed uneventfully within eight months. Using the Enneking functional evaluation system, the mean postoperative score for all 14 patients was 80% (57 to 93). The use of irradiated autograft prosthesis composites reduces the complications of ECIR and gives good functional results. It may be a good alternative in limb-salvage surgery, especially in countries where it is difficult to obtain allografts.

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

“…Radiation doses of 50-300 Gy have been used in some centers with no evidence of local recurrence from irradiated bone segments (6,7,10,16,19,24,25). In a histological study, Davidson et al (6) demonstrated the complete eradication of tumor cells in grafts by a single radiation dose of 50 Gy, which is equivalent to 250 Gy in the conventional fraction using the linear quadratic model.…”

Combined use of free vascularised fibula graft and extracorporeally irradiated osteochondral graft for osteosarcoma of the proximal ulna

“…the functional results were excellent with active movement of the elbow from 5 to 150˚, but joint stability of the elbow was not reported (10). extracorporeal irradiation of tissue followed by reimplantation can be used to replace bone defects following removal of tumors (11)(12)(13)(14)(15)(16)(17)(18)(19). one of the advantages of irradiated bone for reconstructive surgery is the possibility of achieved good joint function, especially where the ligamentous tissues have been preserved, since the ligaments of the patient can be restored to their original shape, size and site (12).…”

“…one of the advantages of irradiated bone for reconstructive surgery is the possibility of achieved good joint function, especially where the ligamentous tissues have been preserved, since the ligaments of the patient can be restored to their original shape, size and site (12). However, the complication rate of this reconstruction, including nonunion, infection and fracture was high (12)(13)(14)(15)(16). recently, favorable results of the combined use of vascularised bone graft and extracorporeally irradiated bone for reconstruction have been reported (18,19).…”

Disinfection of Human Tissues in Orthopedic Surgical Oncology by High Hydrostatic Pressure

“…In orthopedic surgery, restoration of bone defects caused by malignant solid tumors is achieved by several methods of treatment such as extracorporeal irradiation or autoclaving the affected bone segment, as an alternative approach to synthetic limb reconstruction (16)(17)(18)(19). In contrast, irradiation or autoclaving of osteochondral segments or tendons may lead to severe alteration of their biomechanical and biological properties, a major concern regarding this type of approach (20)(21)(22).…”