Limb-sparing reconstruction using extracorporeal irradiation and autograft recycling for primary malignant bone...

Autograft recycling (AR) using extracorporeal irradiation (ECI) enables limb-sparing reconstruction following resection in patients with primary malignant bone tumors (MBTs). We evaluated the oncological and functional outcomes after this procedure in a single-institution cohort.

This retrospective cohort study included patients with MBTs treated between December 2016 and February 2024 with en-bloc resection, AR using a single fraction of 50 Gy ECI, and bone reimplantation.

Twenty patients were included, with a median age of 38 years (min-max range, 18-80). The predominant histological subtypes were chondrosarcoma (N = 10), osteosarcoma (N = 4), and Ewing's sarcoma (N = 3). The pelvis was the most frequently treated site (N = 11), followed by the upper limbs (N = 5) and the lower limbs (N = 3). All patients underwent en-bloc resection followed by a single fraction of 50 Gy ECI and reimplantation of the bone. Median follow-up was 17.1 months (min-max range, 2.5-80.6). The 2 years overall survival (OS) rate was 94.4% (Cl 95%, 83.8-100). Local control at 1 year and 2 years was 100% (Cl 95%, 100-100), and 62.5% (Cl 95%, 29.1-96.1). Functional outcomes were graded as good to excellent in 12 patients (60%) and fair to poor for 8 patients (40%). In multivariate analysis, a larger tumor size was significantly associated with local relapse (p = 0.02), while re-interventions were negatively associated with OS (p = 0.026).

AR using ECI achieved encouraging oncological and functional outcomes in patients with MBTs and represents a valuable reconstructive technique in limb-sparing surgery.