Massive cryo-preserved bone allografts were implanted in 17 patients after segmental resection, 10 for malignant and 7 for benign bone tumours. A segmental graft alone was used in 6 cases, a bone graft with an arthrodesis in 8, and a combination of graft and prosthesis in 1. The tumours were resected widely; the average length of graft was 6.4 cm in benign tumours and 11 cm in malignant tumours. Chemotherapy was given for one year after operation. There were 2 local recurrences, one severe infection, sloughing of the wound in 2, graft absorption in 3 and breakage of metal in 2. Follow up was from 14 months to 12 years. Bone healing was assessed by radiography in 13 cases. All grafted bone in patients receiving chemotherapy failed to heal primarily, as did 3 of the grafts for benign tumours. Secondary rigid fixation and an additional autogenous graft resulted in healing of the bone junction within a year.

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A 4-month old girl was diagnosed as having stage IV neuroblastoma of the right adrenal gland. Preoperative chemotherapy was given, followed by local surgical excision. Postoperatively, irradiation of the tumor bed and adjuvant chemotherapy was given for 11 months. Nine years after cessation of chemotherapy, the patient developed left hip-joint pain. Biopsy of the ischium showed chondroblastic osteosarcoma. Limb salvage surgery was performed after preoperative chemotherapy. Postoperatively, adjuvant chemotherapy was given for 14 months. Twenty-two months after treatment for the secondary osteosarcoma, the patient has been remained in disease-free condition without any evidence of relapse. A second osteosarcoma occurring outside the radiation field after treatment for neuroblastoma is quite rare. This unusual case emphasized the need for close monitoring for development of second malignant neoplasms in survivors of neuroblastoma even in the absence of a known predisposing factor, such as radiation therapy.

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