Comparative study or the effect of extracorporeal irradiation of tumor segment and alcohol inactivation during limb salvage surgery for malignant bone tumors
Tian Zhichao, Cai Qiqing, Wang Xin, Liu Zhiyong, Li Po, Zhang Peng, Yao Weitao, Wang Jiaqiang
Department of Orthopedics, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
Abstract:Objective To compare and analyze the effects of intraoperative extracorporeal irradiation (IEI) and alcohol inactivation (AI) in the surgery of limb salvage in malignant bone tumors, and to provide references for clinical selection of safer and more effective methods of tumor segment bone inactivation.Methods The clinical data of 54 patients with malignant bone tumors who received IEI or AI bone replantation in the surgery of malignant bone tumors at the Affiliated Cancer Hospital of Zhengzhou University from January 2008 to January 2016 without tumor metastasis were retrospectively analyzed. Among the 54 patients, there were 27 males and 27 females, aged 7-58 (20.58±12.89) years. According to the method of bone inactivation and replantation, the patients were divided into the irradiation group (25 patients) and the alcohol group (29 patients). The differences of tumor recurrence, bone healing rate, bone healing time, bone nonunion rate, fracture rate, infection rate and bone absorption rate were compared between the two groups.Results Twenty-five cases were treated with IEI, the average follow-up was 20.48±6.39 months. One patient had local recurrence (4%). Bone healing occurred in 16 patients (64.00%), with an average of (8.75±2.38) months of bone healing time. There were infections in 2 patients (8%). The mean follow-up time of 29 patients receiving AI replantation was (41.79±24.74) months, 5 patients (17.24%) relapsed, 13 patients (44.83%) healed, the mean bone healing time was (25.31±13.62) months, and 2 patients (6.4%) were infected. The healing time of inactivated bone was significantly different between the two groups (P<0.01), and the tumor recurrence, bone healing rate, bone nonunion rate, fracture rate, infection rate and bone absorption rate were not significantly different between the two groups(all P values>0.05).Conclusions Both methods were effective. Irradiation inactivation method is superior to alcohol inactivation method in safety and the mean healing time of inactivated bone. However, irradiation inactivation requires professional equipment and limits its application.
田志超, 蔡启卿, 王鑫, 刘志勇, 李坡, 张鹏, 姚伟涛, 王家强. 切除瘤段骨体外辐照与乙醇灭活再植术在恶性骨肿瘤保肢术中应用效果的对比研究[J]. 中华解剖与临床杂志, 2019, 24(3): 239-244.
Tian Zhichao, Cai Qiqing, Wang Xin, Liu Zhiyong, Li Po, Zhang Peng, Yao Weitao, Wang Jiaqiang. Comparative study or the effect of extracorporeal irradiation of tumor segment and alcohol inactivation during limb salvage surgery for malignant bone tumors. Chinese Journal of Anatomy and Clinics, 2019, 24(3): 239-244.
Sung HW, Wang HM, Kuo DP, et al. EAR method: an alternative method of bone grafting following bone tumor resection (a preliminary report)[J]. Semin Surg Oncol, 1986, 2(2): 90-98.
[2]
Fuchs B, Ossendorf C, LeErapun T, et al. Intercalary segmental reconstruction after bone tumor resection[J]. Eur J Surg Oncol, 2008, 34(12): 1271-1276. DOI:10.1016/j.ejso.2007.11.010.
[3]
Nishida J, Shimamura T. Methods of reconstruction for bone defect after tumor excision: a review of alternatives[J]. Med Sci Monit, 2008, 14(8): RA107-RA113.
Yasin NF, Ajit Singh V, Saad M, et al. Which is the best method of sterilization for recycled bone autograft in limb salvage surgery: a radiological, biomechanical and histopathological study in rabbit[J]. BMC Cancer, 2015, 15: 289. DOI:10.1186/s12885-015-1234-9.
[6]
Xu S, Yu X, Xu M, et al. Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur[J]. BMC Musculoskelet Disord, 2014, 15: 453. DOI:10.1186/1471-2474-15-453.
[7]
Chauhan S, Manoj K, Rastogi S, et al. Biomechanical investigation of the effect of extracorporeal irradiation on resected human bone[J]. J Mech Behav Biomed Mater, 2017, 65: 791-800. DOI:10.1016/j.jmbbm.2016.09.032.
[8]
Koyanagi H, Matsumoto S, Shimoji T, et al. Long-term results from use of pasteurized bone[J]. J Orthop Sci, 2012, 17(5): 605-613. DOI:10.1007/s00776-012-0258-0.
[9]
Jones CW, Shatrov J, Jagiello JM, et al. Clinical, functional and radiological outcomes of extracorporeal irradiation in limb salvage surgery for bone tumours[J]. Bone Joint J, 2017, 99-B(12): 1681-1688. DOI:10.1302/0301-620X.99B12.BJJ-2016-0462.R2.
[10]
Wu PK, Chen CF, Chen CM, et al. Intraoperative extracorporeal irradiation and frozen treatment on tumor-bearing autografts show equivalent outcomes for biologic reconstruction[J]. Clin Orthop Relat Res, 2018, 476(4): 877-889. DOI:10.1007/s11999.0000000000000022.
[11]
Yu XC, Xu SF, Xu M, et al. Alcohol-inactivated autograft replantation with joint preservation in the management of osteosarcoma of the distal femur: a preliminary study[J]. Oncol Res Treat, 2014, 37(10): 554-560. DOI:10.1159/000367799.
[12]
Poffyn B, Sys G, Mulliez A, et al. Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks[J]. Int Orthop, 2011, 35(6): 889-895. DOI:10.1007/s00264-010-1098-1.
[13]
Hong AM, Millington S, Ahern V, et al. Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients[J]. Ann Oncol, 2013, 24(10): 2676-2680. DOI:10.1093/annonc/mdt252.
[14]
Poffyn B, Sys G, Van Maele G, et al. Radiographic analysis of extracorporeally irradiated autografts[J]. Skeletal Radiol, 2010, 39(10): 999-1008. DOI:10.1007/s00256-010-0889-1.
[15]
Yang J, Zhu B, Fu K, et al. The Long-term outcomes following the use of inactivated autograft in the treatment of primary malignant musculoskeletal tumor[J]. J Orthop Surg Res, 2015, 10: 177. DOI:10.1186/s13018-015-0324-3.
[16]
Spira E, Lubin E. Extracorporeal irradiation of bone tumors. A preliminary report[J]. Isr J Med Sci, 1968, 4(5): 1015-1019.
[17]
Murakami H, Demura S, Kato S, et al. Systemic antitumor immune response following reconstruction using frozen autografts for total en bloc spondylectomy[J]. Spine J, 2014, 14(8): 1567-1571. DOI:10.1016/j.spinee.2013.09.030.
[18]
Kotb SZ, Mostafa MF. Recycling of extracorporeally irradiated autograft for malignant bone tumors: long-term follow-up[J]. Ann Plast Surg, 2013, 71(5): 493-499. DOI:10.1097/SAP.0b013e3182a795c1.
[19]
Hayashi K, Araki N, Koizumi M, et al. Long-term results of intraoperative extracorporeal irradiation of autogenous bone grafts on primary bone and soft tissue malignancies[J]. Acta Oncol, 2015, 54(1): 138-141. DOI:10.3109/0284186X.2014.930172.
[20]
Gupta S, Cafferky D, Cowie F, et al. The mechanical effects of extracorporeal irradiation on bone[J]. Bone Joint J, 2015, 97-B(8): 1152-1156. DOI:10.1302/0301-620X.97B8.35729.
[21]
Hatano H, Ogose A, Hotta T, et al. Extracorporeal irradiated autogenous osteochondral graft: a histological study[J]. J Bone Joint Surg Br, 2005, 87(7): 1006-1011. DOI:10.1302/0301-620X.87B7.14822.
[22]
Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Intercalary femur and tibia segmental allografts provide an acceptable altern ative in reconstructing tumor resections[J]. Clin Orthop Relat Res, 2004, (426):97-102.DOI:10.1097/01.blo.0000141652.93178.10,
[23]
Frisoni T, Cevolani L, Giorgini A, et al. Factors affecting outcome of massive intercalary bone allografts in the treatment of tumours of the femur[J]. J Bone Joint Surg Br, 2012, 94(6):836-41. DOI:10.1302/0301-620X.94B6.28680.