A long‐term follow‐up study of extracorporeal irradiated autografts in limb salvage surgery for malignant bone and soft tissue tumors: A minimum follow‐up of 10 years after surgery

Outani, Hidetatsu; Takenaka, Satoshi; Hamada, Kenichiro; Imura, Yoshinori; Kakunaga, Shigeki; Tamiya, Hironari; Wakamatsu, Toru; Naka, Norifumi; Ueda, Takafumi; Araki, Nobuhito

doi:10.1002/jso.25918

Cited by 20 publications

(18 citation statements)

References 19 publications

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“…Because of the long-term results observed by Grimer et al and an increasing risk of complications over time, the option of biological reconstruction becomes more important especially for young patients. The long-term observation of patients after biological reconstruction by irradiated autografts confirms this thesis [ 11 ].…”

Section: Discussionsupporting

confidence: 69%

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Klein¹,

Bakhshai²,

Roeder

et al. 2021

BMC Musculoskelet Disord

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Background Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. Results the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. Conclusions the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

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Section: Discussionsupporting

confidence: 69%

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Klein¹,

Bakhshai²,

Roeder

et al. 2021

BMC Musculoskelet Disord

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“…Reconstruction using devitalized tumor-bearing autografts after bone tumor excision is well-known approach in orthopedic oncology 17 – 32 . Various devitalizing methods are available today, including irradiation 17 – 20 , pasteurization 21 – 23 , and freezing 24 – 32 . Reconstruction using any devitalized autograft received coverage from the social insurance system in Japan in April 2020; the medical expenses borne by patients are now lower, and the surgical procedures can be performed at any hospital in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, devitalized autograft reconstruction received coverage by Japan’s social insurance system in April 2020, and these procedures can be performed at any hospital in Japan. Different types of devitalized autograft are used for reconstruction, including irradiated bone 17 – 20 , pasteurized bone 21 – 23 , and frozen bone 24 – 32 . Autograft reconstruction has been reported to be associated with numerous advantages: the autograft can fit perfectly with the original site, and the retracted tendon or muscles can be reattached, even in cases where autograft-prosthesis composite fixation is performed 29 , 30 .…”

mentioning

confidence: 99%

Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

Araki

Yamamoto

Hayashi

et al. 2021

Sci Rep

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Age affects the clinical outcomes of cancer treatment, including those for bone sarcoma. Successful reconstruction using frozen autograft after excision of bone sarcoma has been reported; however, little is known about the clinical outcomes of frozen autograft reconstruction according to age. The purpose was to evaluate the clinical outcomes of the frozen autograft reconstruction focusing on skeletally mature adolescents and young adults (AYAs) that was 15 to 39 years of age. A total of 37 AYA patients with primary bone sarcoma on the appendicular skeleton were enrolled in this study. The mean follow-up period was 89 months. The graft survival (GS), overall survival (OS), recurrence-free survival (RFS), complications and the function were retrospectively evaluated using medical records. The 10-year GS, OS, and RFS rates were 76%, 84%, and 79%, respectively. Bone union was achieved with a rate of 94% within 1 year after surgery, and nonunion (n = 1) and fracture (n = 2) were infrequently observed. Graft removal was performed in 7 cases, and the most common reason for the removal was infection (n = 5). The Musculoskeletal Tumor Society score was excellent in 23 cases of the available 29 cases. Frozen autograft reconstruction for AYAs showed excellent clinical outcomes, although the long-term follow-up is required.

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“…Currently, it is challenging to surgically repair bone defects caused by bone tumors. Several methods are used to treat such defects, such as arti cial bone 24 , allograft bone 12 , bone cement 4 , autograft bone 11,25 , bone transport 26 and tumor bone inactivation and replantation 27 . Although arti cial bones can repair the defect area, the mechanical stability of such bones is poor, and autogenous bones do not heal effectively.…”

Section: Discussionmentioning

confidence: 99%

“…It is also much cheaper than the allogeneic bone. Elsewhere, various methods have been noted to inactivate tumors including high-temperature water bath inactivation, in vitro irradiation inactivation 27,28 , liquid nitrogen inactivation 29 , and pasteurization inactivation 10,30 . Studies have enumerated that pasteurization has therapeutic effects as a biologic reconstructive option.…”

Section: Discussionmentioning

confidence: 99%

3D Printing Guide Plate for Accurate Hemicortical Bone Resection in Low-Grade Bone Sarcoma

Wu¹,

Li²,

Yang³

et al. 2020

Preprint

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Background: Surgical resection and reconstruction for low grade bone sarcoma in the metaphysis of the long bone remains challenging. We hypothesize that 3D printing osteotomy guide plate could assist to accurately resect the tumor lesion and save the joint function without higher recurrence rate. Methods: From January 2017 to August 2019, ten patients with low-grade malignant bone tumor in metaphysis of the limbs were treated with hemicortical resection using 3D printing guide plate and biological reconstruction. Results: Four patients were paracorticular osteosarcoma, five cases had highly differentiated chondrosarcoma, and one case was a chondromyxoid fibroma. Two of the cases involved the proximal humerus, while eight cases involved the distal femur. There was neither post-operation infection, internal fixation loosening, nor fracture occurrence in any of the patients. The Musculoskeletal Tumor Society score averaged at 27.1, while the International Society of Limb Salvage imaging score examination averaged 87.8%. Conclusions: Here, we demonstrate that the 3D printing osteotomy guide plate assisted hemicortical bone resection is a beneficial strategy to effectively resect the primary low-grade malignant bone tumors in the metaphysis of long bone and restore excellent joint function.

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A long‐term follow‐up study of extracorporeal irradiated autografts in limb salvage surgery for malignant bone and soft tissue tumors: A minimum follow‐up of 10 years after surgery

Cited by 20 publications

References 19 publications

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

3D Printing Guide Plate for Accurate Hemicortical Bone Resection in Low-Grade Bone Sarcoma

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A long‐term follow‐up study of extracorporeal irradiated autografts in limb salvage surgery for malignant bone and soft tissue tumors: A minimum follow‐up of 10 years after surgery

Cited by 20 publications

References 19 publications

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

3D Printing Guide Plate for Accurate Hemicortical Bone Resection&nbsp;in Low-Grade Bone Sarcoma

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3D Printing Guide Plate for Accurate Hemicortical Bone Resection in Low-Grade Bone Sarcoma