Efficacy of Extracorporeal Irradiation in Primary Malignant Bone Tumours: A Tertiary Cancer Centre Experience

Gunaseelan k; Dilip Kumar Patro; Arun Lal; Kannan P; Biswajit D; Vijayaprabhu N

doi:10.31557/apjcc.2019.4.2.53-57

Authors

Gunaseelan k
Dilip Kumar Patro Professor Department of Orthopaedics JIPMER, India. 3Senior Resident, Department of Orthopaedics, JIPMER, India.
Arun Lal Senior Resident, Department of Orthopaedics, JIPMER, India.
Kannan P Senior Resident, Department of Radiation Oncology, JIPMER, India.
Biswajit D Additional Professor, Department of Medical Oncology, JIPMER, India.
Vijayaprabhu N Assistant Professor, Medical Physics, Department of Radiotherapy, JIPMER, India.

DOI:

https://doi.org/10.31557/apjcc.2019.4.2.53-57

Keywords:

Malignant bone tumours- extracorporeal irradiation- prosthesis- sarcomas

Abstract

Background: Limb-sparing approaches involving a combination of surgery, chemotherapy, and radiotherapy are preferred in primary malignant bone tumours whenever possible. The limb function can be maintained by performing reconstruction either using a prosthesis or bone graft. Extracorporeal irradiation is a novel and exciting technique in which the restoration is done using the patient’s own tumour bone. In this article, we present the local control, complications, and functional outcome of 49 cases of primary malignant bone tumours treated using the technique of extracorporeal irradiation.
Materials and methods: 49 patients with primary malignant bone tumours were treated with extracorporeal irradiation between the year 2007 to 2015.En-bloc resection of the tumour and the involved bone along with soft tissues was performed about four weeks after the completion of three to four cycles of neoadjuvant chemotherapy. The bone segment was irradiated with 6MV linear accelerator to a dose of 50Gy. After extracorporeal irradiation, the bone was re-implanted using fixation devices. Local control, relapse-free survival, complications and functional outcome were studied.
Results: Out of 49 patients, there were 33 males and 16 females. The median age was 19 years. Femur and tibia were the most common tumour locations with osteosarcoma being the most common histology (74%). The local control rate was 94%. The 8 year local recurrence-free survival and distant metastasis-free survival were 89% and 84% respectively. The overall complication rate was 20%. Infection was the most frequent complication, observed in 46% of the patients who developed complications. Out of 49 patients, 40 had reported a good range of movements.
Conclusion: Extracorporeal irradiation and re-implantation is a convenient alternative to prosthesis from a health economics point of view, provided severe complications are managed and avoided so that functional results can be achieved.