Extracorporeal irradiation for malignant bone tumors

Purpose: Extracorporeal irradiation (ECI) has been used selectively in the management of primary malignant bone tumors since 1996, We report our techn iques for ECI and the short-term oncologic and orthopedic outcomes. Methods and Materials: Sixteen patients with primary malignant bone tumors were treated with ECI from 1996 to 2000. The median age was 14 years. The h istologic diagnoses were Ewing's sarcoma (11), osteosarcoma (4) and chondro sarcoma (1). The treated sites were femur (7), tibia (4), humerus (2), iliu m (2), and sacrum (1), Following induction chemotherapy in Ewing's sarcomas and osteosarcoma, en bloc resection of the tumor and tumor-bearing bone wa s performed. A single dose of 50 Gy was delivered to the bone extracorporea lly using either a linear accelerator (9 cases) or a blood product irradiat or (7 cases). The orthopedic outcome was recorded using a standard function al scale. Results: At a median follow-up of 19.5 months, there were no cases of local recurrence or graft failure. One patient required amputation due to chroni c osteomyelitis. For the 10 patients with follow-up greater than 18 months, the functional outcomes were graded good to excellent. Conclusion: The short-term oncologic and orthopedic results are encouraging and suggest that ECI provides a good alternative for reconstruction in lim b conservative surgery in selected patients. This technique should only be used in a multidisciplinary setting, where careful follow-up is available t o assess the long-term outcomes. (C) 2001 Elsevier Science Inc.