Reconstructing diaphyseal tumors using radiated (50 Gy) autogenous tumor bone graft

Area of Science:

• Orthopedic Oncology
• Surgical Reconstruction
• Radiation Oncology

Background:

• High-grade extremity tumors often require limb-sparing surgery.
• Reconstruction after tumor resection presents challenges in achieving oncologic control and functional restoration.
• Extracorporeal radiotherapy (ECRT) offers a method to sterilize tumor-bearing bone segments before reimplantation.

Purpose of the Study:

• To establish the oncologic safety of using 50 Gy ECRT to sterilize tumor-bearing bone for reimplantation in primary diaphyseal high-grade extremity tumors.
• To determine the graft survival rate of ECRT segments.
• To analyze factors influencing union at osteotomy sites following ECRT reconstruction.

Main Methods:

• Seventy patients with non-metastatic primary diaphyseal high-grade extremity tumors (osteosarcoma or Ewing's sarcoma) underwent reconstruction with intercalary ECRT grafts sterilized with 50 Gy.
• Follow-up data was collected, including survival status, graft survival, and osteotomy union.
• Statistical analysis was performed to identify factors affecting union and graft survival.

Main Results:

• Metaphyseal osteotomies achieved 91% union without intervention, while diaphyseal osteotomies had 71% union.
• Additional small plates at diaphyseal osteotomies appeared to reduce non-union rates (17% vs 31%).
• Seven local recurrences (10%) occurred, all in soft tissue. Graft removal was necessary in 25% of patients. Five-year ECRT graft survival was 79% (all causes) and 84% (excluding recurrence).

Conclusions:

• Reimplanting tumor bone sterilized with 50 Gy via ECRT is an applicable and oncologically safe biological reconstruction option.
• This technique is suitable for primary diaphyseal high-grade extremity tumors.
• Osteotomy stabilization and careful patient selection are important for successful outcomes.