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Recycling of Extracorporeally Irradiated Autograft for Malignant Bone Tumors: Long-term Follow-up

Kotb, Samir Z. MD; Mostafa, Mohamed F. MD

doi: 10.1097/SAP.0b013e3182a795c1
Hand Surgery

This study was conducted to evaluate the long-term oncological and functional outcomes. Forty-two patients (29 men and 13 women) with primary malignant bone tumors were included in this study. The procedure consisted of wide en bloc resection, clearing the extraosseous soft tissue and medullary content, extracorporeal irradiation with a single dose of 50 Gy using linear accelerator, and reimplantation using suitable fixation devices. The mean survivor follow-up was 54 months (24–174 months). There were 32 (76.2%) patients continuously disease free, 7 (16.7%) died of disease, and 3 (7.1%) alive with disease. Local recurrence was encountered in 4 (9.5%) patients. Nonunion occurred at 3 (6.4%) osteotomy sites. Deep infection developed in 4 (9.5%) cases. There were 13 patients rated excellent, 17 good, 10 fair, and 2 failures according to the Mankin scoring system. The mean ratings of the Musculoskeletal Tumor Society score and the Toronto Extremity Salvage Score were 77 and 81, respectively. The long-term oncological and functional results are encouraging and suggest that extracorporeal irradiation and reimplantation can be a long-lasting biological reconstructive technique in properly selected patients.

From the Department of Orthopedic Surgery, Mansoura University Hospital, Mansoura, Egypt.

Received April 24, 2013, and accepted for publication, after revision, July 29, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Samir Z. Kotb, MD, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria St, PO Box 35516, Mansoura, Egypt. E-mail:

© 2013 by Lippincott Williams & Wilkins