Extracorporeal irradiation for malignant bone tumors

Hong, Angela; Stevens, Graham; Stalley, Paul; Pendlebury, Susan; Ahern, Verity; Ralston, Anna; Estoesta, Edgar; Barrett, Ian R.

doi:10.1016/s0360-3016(01)01460-2

Cited by 52 publications

(51 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Available results have demonstrated excellent oncological outcomes in terms of local control and overall survival (5,6). Previous reports have indicated that ECI and re-implantation of the involved bone were more beneficial than other treatments, including reconstruction using allograft or prosthesis (4)(5)(6)(7). ECI and re-implantation is an economic technique that provides an anatomically size-matched graft for a lifelong biological reconstruction and preservation of joint mobility, thus avoiding the problems of revision due to prosthetic wear.…”

Section: Introductionmentioning

confidence: 99%

“…ECI and re-implantation is an economic technique that provides an anatomically size-matched graft for a lifelong biological reconstruction and preservation of joint mobility, thus avoiding the problems of revision due to prosthetic wear. Additionally, this technique also removes the requirement for bone banks and other problems associated with allografts, including graft rejection and risk of viral transmission (4)(5)(6)(7). ECI and re-implantation of the involved bone was introduced to Southwest Hospital, Third Military Medical University (Chongqing, China) in 2004.…”

Section: Introductionmentioning

confidence: 99%

“…Then the bone was placed into two sterile plastic bags and delivered for radiotherapy. Bone segments were irradiated with 4-6 MV photons from a linear accelerator, having a single midplane dose of 50 Gy at a rate of 1.8-2.0 Gy per min (6,7). For irradiation, each segment was placed in the center of a cylindrical plastic canister and water-equivalent material was used to fill the remaining space.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2017

mol clin onc

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Abstract. Reconstruction of the defect following limb-sparing resection of malignant bone tumors is controversial and extremely challenging. Extracorporeal irradiation (ECI) and re-implantation have been used for limb salvage surgery for patients, with major advantages, including biological reconstruction, ready availability and preservation of bone stock, over replacement with a megaprosthesis. The purpose of the present study was to present our experience and details of all patients treated with this surgery. Between June 2005 and December 2014, we followed-up 23 patients with limb malignancies who were treated with en bloc excision followed by 50-Gy single dose ECI and re-implantation of involved bone segments. All cases were evaluated based on clinical and radiological examinations, complications and Musculoskeletal Tumor Society (MSTS) score. Mean follow-up period was 77.6 months (range, 17-116 months). A total of 17 patients (73.9%) demonstrated no evidence of disease, 5 (21.7%) patients succumbed to the disease and 1 (4.3%) patient was alive with the disease at the final follow-up. Local recurrence occurred in 3 patients (recurrence rate, 13.0%) in the bed outside of the irradiated graft, and 4 of the 5 patients that lost their lives did so due to associated metastatic disease. The mean value of the MSTS score was 78.8% (50-93.3%). The majority of patients demonstrated solid bony union; however, 3 patients had non-union (13.0%) and 1 had a delayed union (4.3%). Early or late complications occurred in 11 patients (47.8%). Although the complication rate (47.8%) and re-operation rate (39.1%) were high, ECI and re-implantation may be a useful and cheap technique following en bloc resection for limb salvage in appropriately selected patients. IntroductionThe current management of musculoskeletal malignancies is limb sparing, and depending on the specific tumor, chemotherapy, surgery and radiotherapy are used in various combinations (1). Surgery is the mainstay of malignant bone tumor treatment with en bloc resection, followed by implantation of autograft, allograft or prosthesis to ensure skeletal continuity (1). Reconstruction, precise fit and stability of the materials are the main challenges to overcome. Different reconstruction methods have different advantages and disadvantages. Aseptic loosening of prosthesis and fracture of the allograft are common problems in clinical practice (2,3).In 1968, Spira and Lubin (4) first reported intra-operative extracorporeal irradiation (ECI) and re-implantation of resected bone as a useful method of limb salvage for malignant bone tumors. However, this method does not have a widespread use according to literature; it has only been used in some cases of osteosarcoma, Ewing sarcoma or chondrosarcoma with minimal lytic destruction or predominantly sclerotic changes (5). The dose of radiation produces a dead autogenous bone graft for re-implantation and reconstruction with correct dimensions. Available results have demonstrated excellent oncological outcomes in terms of loc...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Zhang

Wang

et al. 2017

mol clin onc

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show abstract

“…An alternative option to bone resection is extracorporeal irradiation and reimplantation, a strategy that has been reported extensively as a successful limb-sparing treatment option for tumors involving bone. [4][5][6][7] We present a case of anterior fossa meningioma with tumorous overlying calvarium that was successfully managed with intraoperative extracorporeal irradiation and reimplantation.…”

Section: Introductionmentioning

confidence: 99%