Effect of x-rays and gamma radiations on the bone mechanical properties: literature review

Rahman, Noor Leha Abdul; Khan, Rafiullah; Badshah, Saeed

doi:10.1007/s10561-018-9736-8

Cited by 15 publications

(8 citation statements)

References 56 publications

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“…The negative effects of irradiation on bone biology is well established [16,17]. We did not observe any cases of autograft fracture in our cohort [18]. For irradiated grafts, the cadaver study by Hernandez et al did not show any in uence on the biomechanical properties of the irradiated bone [19].…”

Section: Discussionsupporting

confidence: 47%

Technique and Results after Immediate Orthotopic Replantation of Extracorporeally Irradiated Tumor Bone Autografts with and without Fibular Augmentation in Extremity Tumors

Klein

Bakhshai²,

Roeder

et al. 2021

Preprint

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Background: the reconstruction of the bone defects after 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 an 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 and patients: we were able to include 21 patients with 22 reconstructions. In all cases, the bone tumor was resected with wide margins and irradiated with 300 Gy. The autograft was orthotopically replanted and stabilized by means of osteosynthesis implants. 15 patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a local 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. During follow-up, 59% of patients underwent an average of 2.54 revision surgeries, with the most common reason being pseudarthrosis (6 cases). Complete bony integration of the irradiated autografts was achieved in 81.8% of cases after 13.6 months on average. In case of successful reintegration the autograft was shorter (n.s.). Fibular augmentation with or without microvascular anastomosis/pedicled blood supply did not correlate with the pseudarthrosis rate.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 maintainable joints. However, these patients should be ready to accept longer treatment periods.

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Section: Discussionsupporting

confidence: 47%

Technique and Results after Immediate Orthotopic Replantation of Extracorporeally Irradiated Tumor Bone Autografts with and without Fibular Augmentation in Extremity Tumors

Klein

Bakhshai²,

Roeder

et al. 2021

Preprint

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“…The most recent estimates place the risk of femur fracture at 7%, after treatment with 50-66 Gy, with a median time to fracture of 2 years [62]. Radiation treatment can alter the mechanical strength of the bone [133], making it more prone to fracture after a subclinical force or progress to a complete fracture after the development of a stress reaction. Not only does radiation make the bone more brittle, but it also decreases its capacity to heal.…”

Section: Musculoskeletal Injury From Sts Radiotherapymentioning

confidence: 99%

Neoadjuvant Radiotherapy-Related Wound Morbidity in Soft Tissue Sarcoma: Perspectives for Radioprotective Agents

Callaghan

Hasibuzzaman

Rodman

et al. 2020

Cancers

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Historically, patients with localized soft tissue sarcomas (STS) of the extremities would undergo limb amputation. It was subsequently determined that the addition of radiation therapy (RT) delivered prior to (neoadjuvant) or after (adjuvant) a limb-sparing surgical resection yielded equivalent survival outcomes to amputation in appropriate patients. Generally, neoadjuvant radiation offers decreased volume and dose of high-intensity radiation to normal tissue and increased chance of achieving negative surgical margins—but also increases wound healing complications when compared to adjuvant radiotherapy. This review elaborates on the current neoadjuvant/adjuvant RT approaches, wound healing complications in STS, and the potential application of novel radioprotective agents to minimize radiation-induced normal tissue toxicity.

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“…We used 300 Gy to be on the safe side with respect to tumor necrosis. The negative effects of irradiation on bone biology are well established [ 20 – 22 ]. We did not observe any cases of autograft fracture in our cohort.…”

Section: Discussionmentioning

confidence: 99%

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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Effect of x-rays and gamma radiations on the bone mechanical properties: literature review

Cited by 15 publications

References 56 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

Neoadjuvant Radiotherapy-Related Wound Morbidity in Soft Tissue Sarcoma: Perspectives for Radioprotective Agents

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

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