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Kim, Lee, and Chung: The Reconstruction with Extracorporeal Irradiated Autograft for Osteosarcoma of Extremities
Original Article

J Korean Bone Joint Tumor Soc 2010;16(1):1-7.

Published online: 17 December 2010

DOI: https://doi.org/10.5292/jkbjts.2010.16.1.1

The Reconstruction with Extracorporeal Irradiated Autograft for Osteosarcoma of Extremities

Jae Do Kim, M.D., Gun Woo Lee, M.D., So Hak Chung, M.D.

Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea

Correspondence to: So Hak Chung, M.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 34, Amnam-dong, Seo-gu, Busan 602-702, Korea TEL: +82-51-990-6467 FAX: +82-51-243-0181 E-mail: shchung@kosin.ac.kr

Received 30 March 20104 May 2010       Accepted 20 May 2010

Copyright © 2010 The Korean Bone and Joint Tumor Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 longterm 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 followup 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.

Keywords: osteosarcoma, autograft, extracorporeal irradiation (ECI)

REFERENCES

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Figure 1.
K-M Graph for overall survivor rate and disease free survivor rate.
jkbjts-16-1f1.tif
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).
jkbjts-16-1f2.tif
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).
jkbjts-16-1f3.tif
Figure 4.
After removal of irradiated bone, tumor prosthesis was inserted.
jkbjts-16-1f4.tif
Table 1.
MSTS Functional Results according to Locations of Osteosarcoma
  Total MSTS score (%)
Distal femur 15 61.7
Proximal tibia 3 73
Humerus 3 61.6
Proximal fibula 3 69.7
Proximal femur 2 59.9
Distal tibia 2 76
Pelvis 2 70
Calcaneus 1 70
Table 2.
Summarized Data on 31 Patients Reconstructed by ECI for Osteosarcoma
Case No Age/ Sex Diagnosis Site F/u Resection margin Reconstruction method Oncologic result Metastatic lesion MSTS
 Complication Final operation
Scor re (%)
1 24/M Osa DT 177 Intercalary ECI CDF   29 76    
2 47/F Osa DF 84 Intercalary ECI DOC   25 66.6    
3 15/F Osa DF 163 Osteoarticular ECI CDF   26 66.6 Epiphyseal collapse Tumor prosthesis
4 27/M Osa DF 153 Total joint ECI CDF   26 66.6 Joint instability  
5 19/M Osa PFi 148 Osteoarticular ECI CDF   25 66    
6 17/F Osa DF 148 Total joint ECI CDF   26 66.6 Nonunion Tumor prosthesis
7 48/M Osa DF 77 Intercalary ECI CDF   27 70 Nonunion c metal failure Tumor prosthesis
8 14/M Osa DT 141 Osteoarticular ECI NED Lung 29 76 Nonunion Vascurized fibular graft
9 9/M Osa DF 138 Osteoarticular ECI CDF   23 56.6 Infection Tumor prosthesis
10 14/M Osa Calcaneus 138 Osteoarticular ECI CDF   19 43.3   BK amputation
11 34/F Osa PT 126 Total joint ECI CDF   29 76 Joint instability Tumor prosthesis
12 25/M Osa PFi 134 Fragmentary ECI CDF   29 76    
13 14/M Osa PT 130 Osteoarticular ECI CDF   21 50 LLD Tumor prosthesis
14 16/M Osa PFi 17 Fragmentary ECI DOD Lung 25 66.6 Local recurrence AK amputation
15 16/F Osa PH 100 Osteoarticular ECI CDF   25 66.6    
16 13/M Osa PH 97 Osteoarticular ECI CDF   21 50 Nonunion B/G
17 12/M Osa DF 88 Osteoarticular ECI NED Lung 21 50 Fracture OR/IF c plate c B/G
18 7/M Osa DF 119 Osteoarticular ECI CDF   26 66.6 Infection Curettage, metal change
19 15/M Osa PH 145 Osteoarticular ECI CDF   26 66.6 Fracture OR/IF c plate
20 16/M Osa DF 128 Total joint ECI CDF   25 66.6 Joint instability Tumor prosthesis
21 46/M Osa Pelvis 79 Osteoarticular ECI CDF   26 66.6 Nonunion B/G
22 40/M Osa PF 60 Osteoarticular ECI DOD Lung 26 66.6 Nonunion B/G
23 8/F Osa DF 153 Osteoarticular ECI NED Lung 26 66.6 Infection Curettage
24 19/M Osa DF 22 Intercalary ECI DOD Lung 26 66.6    
25 18/F Osa Pelvis 84 Osteoarticular ECI CDF   27 70    
26 8/F Osa DF 172 Osteoarticular APC CDF   26 66.6 LLD Lenthening
27 74/M Osa DF 156 Osteoarticular APC DOD Lung 21 50 Metal failure Screw change
28 44/F Osa PF 148 Osteoarticular APC CDF   22 53.3 Nonunion B/G
29 17/M Osa DF 146 Total joint APC CDF   23 56.6 Nonunion Revision
30 13/M Osa PT 90 Osteoarticular APC DOD Lung 26 66.6    
31 12/F Osa DF 117 Osteoarticular APC DOD Lung 29 76    

Osa, osteosarcoma; DT, distal tibia; DF, distal femur; PFi, proximal fibula; PT, proximal tibia; PH, proximal humerus; PF, proximal femur.

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