Abstract 116P
Background
The standard management approach for malignant bone tumours (MBT) is multidisciplinary, especially when there is a concern for limb salvage. In extracorporeal irradiation (ECI), the tumour-bearing segment of bone is excised en bloc; the tumour and the soft tissues are then removed from the bone, and the bone is irradiated and then reimplanted back into the body. Here we have analysed the results of six patients of MBT treated with this technique.
Methods
Six patients with primary MBT were treated with ECI between the year 2018 to 2022. The eligibility criteria included histopathological proof of malignancy, no evidence of distant metastases, and suitability for limb preservation therapy. Patients were treated with chemotherapy as per standard protocol. Surgery was performed about four weeks after the completion of neoadjuvant chemotherapy. The bone segment was irradiated by external beam radiotherapy to a dose of 50 Gray (Gy). After extracorporeal irradiation, the bone was re-implanted using fixation devices. Local control, complication, survival and functional outcomes were studied.
Results
Out of six patients, four were males, and two were females. The median age of presentation was 22 months. The tibia was the most common bone involved (n=3), followed by the femur (n=2), and one patient presented with a mass in the humerus. Histopathologically, four patients had Ewing sarcoma (ES), and two had osteosarcoma. Two patients with ES received an additional dose of 50.4 Gy at the local site. The median follow-up period was 22 months. At the time of the last review, all the patients were alive, and three developed distant metastases. Non-union occurred in one patient and malunion in one patient. The median progression-free survival was 21 months. One patient developed a postoperative site infection, which was controlled with conservative treatment.
Conclusions
Limb salvage using en-bloc resection followed by intraoperative extracorporeal irradiation and re-implantation of involved bone is a valuable and cheap reconstruction method with minimal complications and decent short-term survival outcomes. Our study also showed that an additional radiation dose could safely be given to selected patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.