Limb-sparing reconstruction using extracorporeal irradiation and autograft recycling for primary malignant bone tumors

Autograft recycling (AR) using extracorporeal irradiation (ECI) enables limb-sparing reconstruction following resection in patients with primary malignant bone tumors (MBTs).We evaluated the oncological and functional outcomes after this procedure in a single-institution cohort. Materials and methodsThis retrospective cohort study included patients with MBTs treated between December 2016 and February 2024 with en-bloc resection, AR using a single fraction of 50 Gy ECI, and bone reimplantation. ResultsTwenty patients were included, with a median age of 38 years (min-max range, 18-80).The predominant histological subtypes were chondrosarcoma (N=10), osteosarcoma (N=4), and Ewing's sarcoma (N=3).The pelvis was the most frequently treated site (N=11), followed by the upper limbs (N=5) and the lower limbs (N=3).All patients underwent en-bloc resection followed by a single fraction of 50 Gy ECI and reimplantation of the bone.Median follow-up was 17.1 months (min-max range, 2.5-80.6).The 2 years overall survival (OS) rate was 94.4% (Cl 95%,.Local control at 1 year and 2 years was 100% (Cl 95%, 100-100), and 62.5% (Cl 95%, 29.1-96.1).Functional outcomes were graded as good to excellent in 12 patients (60%) and fair to poor for 8 patients (40%).In multivariate analysis, a larger tumor size was significantly associated with local relapse (p=0.02), while re-interventions were negatively associated with OS (p=0.026). ConclusionAR using ECI achieved encouraging oncological and functional outcomes in patients with MBTs and represents a valuable reconstructive technique in limb-sparing surgery.