Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint

Sabo, Desiderius; Brocai, D. R. C.; Eble, Michael J.; Wannenmacher, M; Ewerbeck, Volker

doi:10.1302/0301-620x.82b2.0820276

Cited by 19 publications

(24 citation statements)

References 44 publications

(52 reference statements)

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“…For complete eradication, bone tumours require an irradiation dose of at least 80 Gy with a higher dose required under anoxic conditions. 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].…”

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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“…Other studies have also conformed this point of view and believe this dose should be sufficient to produce a tumor elimination rate of 100% (23,26). Studies by Sabo et al (27) and Currey et al (28) have demonstrated a radiation dose-dependent reduction in strength and also suggested reduced revascularization and osteoconductive properties, thereby increasing the time to union and incorporation. Therefore, the present study used a radiation dose of 50 Gy.…”

Section: Discussionmentioning

confidence: 78%

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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“…Higher doses have been shown to reduce the revascularization and osteoconductive capability of the graft, thereby increasing the time to union and incorporation [30-32]…”

Section: Discussionmentioning

confidence: 99%

Which is the best method of sterilization of tumour bone for reimplantation? a biomechanical and histopathological study

Singh

Nagalingam

Saad

et al. 2010

BioMedical Engineering OnLine

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IntroductionSterilization and re-usage of tumour bone for reconstruction after tumour resection is now gaining popularity in the East. This recycle tumour bone needs to be sterilized in order to eradicate the tumour cells before re-implantation for limb salvage procedures. The effect of some of these treatments on the integrity and sterility of the bone after treatment has been published but there has yet been a direct comparison between the various methods of sterilization to determine the one method that gives the best tumour kill without compromising the bone's structural integrity.MethodThis study was performed to evaluate the effect of several sterilization methods on the mechanical behavior of human cortical bone graft and histopathology evaluation of tumour bone samples after being processed with 4 different methods of sterilization. Fresh human cortical tumour bone is harvested from the diaphyseal region of the tumour bone were sterilized by autoclave (n =10); boiling (n =10); pasteurization (n =10); and irradiation (n =10). There were also 10 control specimens that did not receive any form of sterilization treatment. The biomechanical test conducted were stress to failure, modulus and strain to failure, which were determined from axial compression testing. Statistical analysis (ANOVA) was performed on these results. Significance level (α) and power (β) were set to 0.05 and 0.90, respectively.ResultsANOVA analysis of 'failure stress', 'modulus' and 'strain to failure' demonstrated significant differences (p < 0.05) between treated cortical bone and untreated specimens under mechanical loading.'Stress to failure' was significantly reduced in boiled, autoclaved and irradiated cortical bone samples (p < 0.05). 'Modulus' detected significant differences in the boiled, autoclaved and pasteurization specimens compared to controls (p < 0.05). 'Strain to failure' was reduced by irradiation (p < 0.05) but not by the other three methods of treatments.Histopathology study revealed no viable tumour cell in any of four types of treatment group compared to the untreated control group.ConclusionsSterilization of cortical bone sample by pasteurization and to a lesser extent, irradiation does not significantly alter the mechanical properties when compared with untreated samples. Mechanical properties degrade with the use of high temperature for sterilization (boiling). All methods of sterilization gave rise to 100 percent tumour kill.

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Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint

Cited by 19 publications

References 44 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

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

Which is the best method of sterilization of tumour bone for reimplantation? a biomechanical and histopathological study

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