Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

Abstract

Age affects the clinical outcomes of cancer treatment, including those for bone sarcoma. Successful reconstruction using frozen autograft after excision of bone sarcoma has been reported; however, little is known about the clinical outcomes of frozen autograft reconstruction according to age. The purpose was to evaluate the clinical outcomes of the frozen autograft reconstruction focusing on skeletally mature adolescents and young adults (AYAs) that was 15 to 39 years of age. A total of 37 AYA patients with primary bone sarcoma on the appendicular skeleton were enrolled in this study. The mean follow-up period was 89 months. The graft survival (GS), overall survival (OS), recurrence-free survival (RFS), complications and the function were retrospectively evaluated using medical records. The 10-year GS, OS, and RFS rates were 76%, 84%, and 79%, respectively. Bone union was achieved with a rate of 94% within 1 year after surgery, and nonunion (n = 1) and fracture (n = 2) were infrequently observed. Graft removal was performed in 7 cases, and the most common reason for the removal was infection (n = 5). The Musculoskeletal Tumor Society score was excellent in 23 cases of the available 29 cases. Frozen autograft reconstruction for AYAs showed excellent clinical outcomes, although the long-term follow-up is required.

Figure 1

Graft survival (GS) in the three age group patients who underwent frozen autograft reconstruction. The 5- and 10-year GS rates in AYA patients (n = 37) were 86% and 76%, while those in children (n = 27) and older adult patients (n = 16) were 80% and 55%, and 79% and 39%, respectively (p = 0.79).

Figure 2

Overall survival (OS) in the three age group patients who underewent frozen autograft reconstruction. Excluding the cases with distant metastasis observed at the first visit, the 5-year and 10-year OS rates in AYA patients (n = 27) were 84% and 84%, while those in children (n = 5) and older adult patients (n = 15) were 85% and 85%, and 86% and 86%, respectively (p = 0.98).

Figure 3

Recurrence-free survival (RFS) in the three age group patients who underwent frozen autograft reconstruction. The 5- and 10-year RFS rates in AYA patients (n = 37) were 79% and 79%, while those in children (n = 27) and older adult patients (n = 16) were 85% and 78%, and 94% and 85%, respectively (p = 0.72).

Figure 4

Free freezing procedure. The bone tumor is excised en bloc with an adequate margin. After curettage inside the bone specimen and removal of the surrounding soft tissue, the bone specimen was immersed and frozen for 20 min in liquid nitrogen. After thawing, the devitalized bone was fixed to the residual healthy bone on the original site with double locking plates.

Figure 5

Pedicle freezing procedure. The bone tumor is excised with a pedicle to the healthy bone with an adequate margin. After curettage inside the tumor-bearing bone and removal of the surrounding soft tissue, the remaining bone was turned upside down, and then immersed and frozen for 20 min in liquid nitrogen. After thawing, the devitalized bone was fixed to the residual healthy bone on the original site with double locking plates.