Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery

There are several procedures for reconstruction of bony defects after resec tion of malignant musculoskeletal tumors. The clinical results of intraoper ative extracorporeal autogenous irradiated bone grafts in 20 patients with musculoskeletal tumors are discussed. The authors' method of treatment cons ists of: (1) wide en bloc resection of the tumor with involved hone; (2) cu rettage of the tumor from the resected bone; (3) extracorporeal irradiation with 50 Gy as a bolus single dose to the isolated hone; and (4) reimplanta tion of the irradiated bone into the host with fixation devices. Twelve bon e sarcomas and eight soft tissue sarcomas with bone involvement were treate d surgically with this reconstruction method after wide resection of the tu mors. The irradiated bone was used as an intercalary graft in seven cases, as an osteoarticular graft in 11 cases, and as a hemicortical graft in two cases. The theoretical advantages of this method are certain sterilization of tumor cells with radiation, easy availability and good adaptation of siz e and shape, no risk of disease transmission, preservation of bone stock an d ligamentous tissue, and no Immunologic reaction. Radiologically, bony uni on occurred in 23 of 29 (79%) osteotomy sites, The overall radiographic eva luation rating was 74% and the functional rating was 73% according to the I ntel national Society of Limb Salvage rating system, Nonunion (20%) and inf ection (15%) were the tno major complications. Preservation of the tendon i nsertions and ligamentous structures of the irradiated bone seemed to resto re excellent joint function. No local recurrence was detected from the irra diated bones during the mean followup of 45 months, These results indicate intraoperative extracorporeal irradiated bone graft can be a widely applica ble method for reconstruction in tumor surgery.