The long-term outcomes following the use of inactivated autograft in the treatment of primary malignant musculoskeletal tumor

Abstract

Background: Biological reconstruction surgery is a tough but alluring option for treating primary malignant musculoskeletal tumors. In this article, we evaluate the clinical outcomes of primary malignant musculoskeletal tumors treated with inactivated autograft using alcohol.

Method: In this article, we include 58 patients who had primary malignant bone tumors treated with wide resection and recycling autograft reconstruction using alcohol between January 2003 and January 2013. The outcomes were measured by recurrence, functional status, and complications. Functional status was assessed according to the Musculoskeletal Tumor Society Score (MSTSS). The Kaplan-Meier survival curve was used to evaluate the survival rate of the patient.

Result: The most common tumor was osteosarcoma (31 cases) followed by chondrosarcoma (10 cases). The tibia was the most frequently involved skeletal site (27 cases) followed by femur (26 cases). The median follow-up period was 54 months, ranging from 18 to 96 months. In 58 patients, 12 were with local recurrence (20.7 %), 16 with lung metastasis (27.6 %), and 13 with complications (22.4 %). The main complication was infection (8 cases). The autografts survived in 49 patients (84.5 %). The mean MSTSS score was 78.5 %, ranging from 47 to 98 %.

Conclusion: Recycling autograft reconstruction using alcohol had favorable clinical outcomes to some degree; however, the recurrence and complication rates seem to be high. Thus, we should apply this method with caution and choose the patients with strict surgical indication.

Fig. 1

The 5-year survival rate. The mean survival period was 75.2 months (60–90), and 25 patients were alive and tumor-free, of which 16 osteosarcoma, 6 chondrosarcoma, 2 giant cell tumor of bone, and 1 mucus chondrosarcoma. Thus, the 5-year survival rate was 43.1 %. Sixteen patients died of lung metastasis, of which nine patients had local recurrence and lung metastasis (two patients received postoperative amputation and resection of lung metastatic foci). Eleven patients died of complications including infection, cachexia, and renal failure. Four patients died of other diseases and two patients died of reaction of chemotherapy

Fig. 2

Case presentation I. Case 43: A 19-year-old man was diagnosed as having osteosarcoma in the distal of his left femur and was treated with wide resection and inactivated autograft using alcohol. a Plain radiography before surgery. b MRI before surgery. c Inactivated autograft by alcohol in surgery. d Three months after surgery. e One year after surgery. f Two years after surgery

Fig. 3

Case presentation II. Case 37: A 45-year-old woman was diagnosed as having chondrosarcoma in the distal of her left femur and was treated with wide resection and inactivated autograft using alcohol. a Plain radiography before surgery. b MRI before surgery. c Inactivated autograft by alcohol in surgery. d Three months after surgery. e One year after surgery. f Two years after surgery