Outcome of Reconstruction with Irradiated Tumour Bone in Paediatric Malignant Bone Tumours

Reconstruction of a paediatric bone tumour after wide excision is challenging. Autologous sterilized tumour bone provides a perfect fit, avoids wear and tear of the prosthesis, and promises longevity of reconstruction. Here we present our experience on wide excision and reconstruction with irradiated tumour bone at our institution which is a high-volume paediatric sarcoma care centre. This is a retrospective analysis of 53 paediatric patients who underwent reconstruction with irradiated tumour bone between 01/01/2011 and 31/12/2021. The median follow-up period was 64 months (6-112 months) and 83.3% of patients had a minimum follow-up of 3 years. There were 44 diaphyseal osteotomies and 42 metaphyseal osteotomies. Short-term complications were seen in ten patients (18.9%). The long-term complications were high, but 65% of cases were successfully managed and at the time of analysis, only 15 patients had morbidity related to long-term complications. A total of seven patients (13.2%) had persistent nonunion even after additional procedures like bone grafting and refixation. There were four isolated local recurrences in our series (7.5%), and all of these occurred in the soft tissue. The 5-year overall survival was 75.7%, and 5-year disease-free survival was 63%. Reconstruction with irradiated tumour bone is an oncologically safe procedure with acceptable morbidity. Although it is not a procedure without complications, it is an excellent option for reconstruction in paediatric bone tumours.