J Korean Bone Joint Tumor Soc.  2010 Jun;16(1):1-7. 10.5292/jkbjts.2010.16.1.1.

The Reconstruction with Extracorporeal Irradiated Autograft for Osteosarcoma of Extremities

• Kim JD
• Lee GW
• Chung SH

• KMID: 2006335
• DOI: http://doi.org/10.5292/jkbjts.2010.16.1.1

Abstract

PURPOSE
With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications.
MATERIALS AND METHODS
We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed.
RESULTS
The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%.
CONCLUSION
Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

Keyword

osteosarcoma; autograft; extracorporeal irradiation (ECI)

MeSH Terms

Amputation
Disease-Free Survival
Extremities
Female
Femur
Fibula
Follow-Up Studies
Humans
Humerus
Joint Instability
Limb Salvage
Male
Neoplasm Metastasis
Osteosarcoma
Periprosthetic Fractures
Recurrence
Replantation
Retrospective Studies
Survival Rate
Tibia
Ursidae

Figure

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  Figure 1. K-M Graph for overall survivor rate and disease free survivor rate.

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  Figure 2. 46 years-old male patient. Preoperative radiograph shows osteosarcoma in the distal femur which invade articular cartilage and knee joint (A, B, C).

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  Figure 3. After total joint type resection, resected bone was reimplanted after extracoporeal irradiation (A, B). About postoperative 6months, joint instability and epiphyseal collapse was occurred (C, D).

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  Figure 4. After removal of irradiated bone, tumor prosthesis was inserted.

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