Comparative efficacy of intraoperative extracorporeal irradiated and alcohol-inactivated autograft reimplantation for the management of osteosarcomas-a multicentre retrospective study

Abstract

Background: Biologic bone reconstruction in limb salvage surgery for the treatment of malignant bone tumours has always been controversial. The various inactivation methods, their convenience and stability, the curative effects elicited and associated costs all need to be considered. This study aimed to compare the clinical efficacy of intraoperative extracorporeal irradiated reimplantation with alcohol-inactivated autograft reimplantation for limb salvage surgery in patients with osteosarcoma.

Methods: We retrospectively analysed 28 patients with osteosarcoma, 14 patients treated with intraoperative cobalt 60 irradiation and reimplantation (group A), and 14 patients treated by alcohol-inactivated autograft reimplantation (group B). The postoperative complications and clinical efficacy of each treatment method were compared by statistical analysis.

Results: The local recurrence rate was 14.3% in each group. Complete bony union was achieved in 64.3% of patients in group A and 71.4% of patients in group B. The overall 5-year survival rate was 71.4% in group A and 78.6% in group B. The mean Musculoskeletal Tumor Society (MSTS) score was 25.33 ± 4.72 (range 15-30) in group A and 24.00 ± 5.85 (range 15-30) in group B, and the mean International Society of Limb Salvage (ISOLS) score was 25.79 ± 5.13 (range 20-36) in group A and 26.14 ± 5.33 (range 20-30) in group B. P < 0.05 was considered to indicate a significant difference. The results showed that the long-term clinical efficacy did not differ significantly between the two methods.

Conclusions: In limb salvage surgery for osteosarcoma, intraoperative extracorporeal irradiation and alcohol-inactivated autograft reimplantation yielded equivalent outcomes. The alcohol-inactivated method may be a much more convenient and inexpensive way to reconstruct bone defects. Additional studies as well as more case studies are needed to fully evaluate the clinical efficacy and safety of this treatment method.

Keywords: Alcohol-inactivated; Bone defects; Cobalt-irritated; Osteosarcoma; Reimplantation.

Fig. 1

A Prechemotherapy X-ray examination showing osteolytic bone destruction in the left distal femur of a 7-year-old male patient who underwent joint preservation intraoperative extracorporeal inactivated autograft replantation for osteosarcoma of the distal femur. Bone destruction was observed on the medial side, with a local soft tissue mass and periosteal reaction. B Two months after chemotherapy, the X-ray examination revealed that osteolytic bone destruction had markedly decreased in the distal femur. The soft tissue mass had disappeared. C Postchemotherapy coronal MRI scan shows a mix of high and low signals inside the medullary cavity. The surrounding soft tissue and bone marrow response area were clearly demarcated. D After 30 min and 50 Gy dose irradiation by cobalt 60, the 13 cm length of inactivated autogenous segment was returned for reconstruction. E The radiographs taken 1 week after surgery showed apparent reduction of the distal femur by solid internal fixation and joint preservation. F Four months after surgery, the X-ray examination revealed bone healing and a normal joint space. G The X-ray examination showed excellent bone healing, and the internal fixation device was removed 2 years after limb salvage surgery. H At the 4-year follow-up, the full-length X-ray of the left lower extremity showed that the extremity was approximately 5 cm shorter than normal

Fig. 2

A Prechemotherapy X-ray examination showing osteolytic bone destruction in the right proximal tibia of an 18-year-old male patient who underwent joint preservation alcohol-inactivated autograft replantation for osteosarcoma. B Prechemotherapy coronal and sagittal MRI scans show a mix of high and low signals inside the medullary cavity of the tibia and surrounding soft tissue. C Two months after chemotherapy, the X-ray examination revealed that osteolytic bone destruction had markedly decreased. D The photo taken during surgery showed that the alcohol-inactivated autograft segment was filled with bone cement in the bone defect of the medial tibial plateau, replanted for reconstruction and firmly fixed by intramedullary nail fixation. E Radiographs taken 1 week after surgery showed solid internal fixation and joint preservation of the knee. F At 1 year after surgery, the X-ray examination revealed bone healing, but articular space narrowing was observed. G X-ray taken 3 years after limb salvage surgery. H At the 7-year follow-up, the X-ray examination of the right knee showed the condition of the alcohol-inactivated autograft segment. The subchondral bone was partially resorbed and fractured, narrowing of the space was observed, and arthrosis was indicated

Fig. 3

The Kaplan-Meier modelling results for 5-year overall survival are shown