Extracorporeal irradiation and incorporation of bone grafts: Autogeneic cortical grafts studied in rats

Voggenreiter, G.; Ascherl, R.; Blümel, G.; Schmit-Neuerburg, K. P.

doi:10.3109/17453679608997761

Cited by 41 publications

(39 citation statements)

References 14 publications

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“…Doses above 27,000 Gy affect the biomechanical properties of a bone graft [22]. The frequency of delayed unions for irradiated autografts at 12 weeks in rats has been related to the irradiation dose: 16% at 1 kGy, 24% at 5 kGy, and 100% at 25 kGy [23]. At 50 kGy, all grafts were fractured, and the series was interrupted.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Poffyn

Sys

Mulliez

et al. 2010

International Orthopaedics (SICOT)

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We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At fiveyear follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.

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Section: Discussionmentioning

confidence: 99%

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Poffyn

Sys

Mulliez

et al. 2010

International Orthopaedics (SICOT)

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“…This technique has been described in the maxillofacial and orthopedic literature for malignant musculoskeletal tumors, where the involved tumorous bone is resected, irradiated extracorporeally, and reimplanted. 3,6,10,11,15,21,25,32 Recently, long-term studies (mean follow-up range of 45-66 months) indicated no local tumor recurrence at the extracorporeally irradiated skeletal bone. 2,3,6,21 Both animal and in vitro human studies directly comparing autoclaving with irradiation indicated a superior biomechanical profile and better incorporation of the reimplanted bone with irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…Animal studies utilizing intraoperative extracorporeal irradiation with lower doses have demonstrated excellent incorporation of the bone graft without structural integrity compromise. 7,26,32 Extracorporeal irradiation to sterilize tumorous autologous bone graft has been successfully used in malignant musculoskeletal tumors. However, to our knowledge, there is only 1 report utilizing this technique in neurooncological pathologies, 16 aside from our original prior case report.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal irradiation of tumorous calvaria: a case series

Tavanaiepour

Broaddus

Chung

et al. 2015

JNS

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OBJECT When intracranial tumors invade the overlying skull, gross resection typically includes removal of the involved bone. Methods used to repair the resulting structural defect in the cranium include artificial prostheses, allogeneic bone grafts, and autoclaving the autologous graft. The authors have previously reported a case involving high-dose extracorporeal ionizing radiation to treat the tumorous calvaria intraoperatively, followed by reimplantation of the treated bone flap. In this paper the authors report the long-term follow-up of that case, as well as results of using extracorporeal irradiation of tumorous calvaria (EITC) for an additional 20 patients treated similarly. METHODS The decision to undergo EITC was typically anticipated preoperatively, but determined intraoperatively, if upon inspection the bone flap was invaded by tumor. The bone flap was then delivered to the radiation oncology department, where a total dose of 120 Gy was delivered, using a clinical linear accelerator, over a period of approximately 15 minutes. After the intracranial tumor resection was completed, the irradiated craniotomy bone flap was reimplanted and the wound was closed in a standard fashion. A retrospective review of patients who had undergone EITC was performed for evidence of calvarial tumor recurrence or other complications. RESULTS Since the originally reported case, 20 additional patients have received EITC during craniotomy for invasive tumors. Eighteen (86%) of 21 patients were diagnosed with meningioma: 12 (67%) with WHO Grade I, 5 (28%) with WHO Grade II, and 1 with WHO Grade III (6%). The remaining 3 patients presented with dural-based B-cell lymphoma with extensive adjacent bone invasion (n = 2) and metastatic adenocarcinoma of the lung (n = 1). Follow-up of the 21 patients ranged from 1 to 132 months, with a mean of 41 months and a median of 23 months. No patients have experienced tumor recurrence, infection associated with the treated calvaria, or evidence of bone flap resorption. CONCLUSIONS Calvaria reconstructions represent an important component in structural and cosmetic outcome following craniectomy for tumorous bone. The authors' long-term experience with EITC has been excellent with no local tumor recurrence or complications. Therefore, EITC represents an excellent and efficient option for cranial reconstruction in such patients.

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“…On the other hand, various studies on chemical disinfection using ethylene oxide gas, chlorhexidine, povidine iodine 6 or gamma irradiation 7,8 has shown conflicting results regarding disinfection efficacy and there exist no clear guidelines regarding substance concentration and duration for exposure. In our case we soaked bone fragment in 10% povidine-iodine for 20 min; Mazurek used chlorhexidine instead to achieve disinfection.…”

Section: Discussionmentioning

confidence: 99%

Reimplantation of contaminated extruded segment of lateral femoral condyle cleansed with 10% povidine-iodine in complex floating knee injury with excellent outcome: Case report with 2 year follow up

Singhi¹,

Sivakumar²,

Somashekar³

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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Extracorporeal irradiation and incorporation of bone grafts: Autogeneic cortical grafts studied in rats

Cited by 41 publications

References 14 publications

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Extracorporeal irradiation of tumorous calvaria: a case series

Reimplantation of contaminated extruded segment of lateral femoral condyle cleansed with 10% povidine-iodine in complex floating knee injury with excellent outcome: Case report with 2 year follow up

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