Reconstruction of Total Bone Defects following Resection of Malignant Tumors of the Upper Extremity with 3D Printed Prostheses: Presentation of Two Patients with a Follow-Up of Three Years

Wide tumor resection is the local treatment of choice for patients with primary malignant bone tumors and a prerequisite for long-term survival. We present two patients that underwent total bone resection in the upper limb because of primary malignant bone tumors. The defects were then reconstructed by a 3D printed prosthesis, a procedure that, to our knowledge, has not been reported for bone defects of the upper extremity so far. Complete resection of the affected bone was required in a five-year-old girl with a high-grade osteoblastic osteosarcoma of the humerus and a 53-year-old man with a dedifferentiated leiomyosarcoma of the radius, due to the tumor’s extent. Following neoadjuvant chemotherapy, resection of the entire affected humerus including the axillary nerve took place in the first case and the entire affected radius including parts of the radial nerve in the second case. Approximately three years after surgery, both patients are alive and pain-free. Despite a postoperative drop hand that affected the now 56-year-old man, he is able to carry out everyday activities such as brushing his teeth, writing, and eating. The now eight-year-old girl is also able to engage in normal activities with her left arm such as eating and carrying lightweight objects. Both patients are tumor-free to date.

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Endoprosthetic Reconstruction in Limb Salvage for Malignant Bone Tumours in Children

Journal of Orthopedics and Orthopedic Surgery ◽

10.29245/2767-5130/2021/2.1135 ◽

2021 ◽

Vol 2 (2) ◽

pp. 4-8

Author(s):

Sagar Tontanahal ◽

Gahukamble Abhay Deodas ◽

Deeptiman James ◽

Anand Kurian ◽

Thomas Palocaren

Keyword(s):

Limb Salvage ◽

Bone Tumors ◽

Rapid Development ◽

Tumor Resection ◽

Limb Salvage Surgery ◽

Endoprosthetic Reconstruction ◽

Malignant Bone Tumors ◽

Musculoskeletal Tumor Society ◽

Prosthetic Reconstruction ◽

Malignant Bone Tumours

Background: The management of malignant bone tumors in children has come a long way in the past few decades. The transition from amputation to limb salvage has been made possible due to the rapid development in the diagnosis and the oncological management of these malignant tumors. However, there exist significant reservations regarding endoprosthetic reconstruction in children. Material and methods: A mini-review was conducted of articles detailing the use of prosthetic reconstruction following tumor resection in children. The data regarding complications and functional outcomes following surgery were collected and presented. Results: The studies reviewed reported a 5-year survival rate between 60 – 70 %. Uniform across the studies was the need for multiple surgeries when endoprosthesis was used for limb reconstruction, ranging between 2.8 – 3.5 surgeries. The most common complication noted across the studies was related to soft tissue problems such as joint instability followed by structural failure of the prosthesis. Infections were noted with a frequency of 10 – 15 %. Studies showed successful management of limb length discrepancy with expandible prosthesis. Musculoskeletal Tumor Society (MSTS) score used to evaluate the functional outcome showed satisfactory outcomes. Conclusion: Limb salvage surgery, with recent advances in technique and prosthesis design, is an attractive option in children with extremity malignant bone tumors. In recent time, endoprosthetic reconstruction of extremities have yielded good functional results and are well accepted by the child and the parents. The purpose of this mini-review is to shed some light on the use of endoprosthetic reconstruction in children following tumor resection with its potential benefits and drawbacks.

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Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04629-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Alexander Klein ◽

Yasmin Bakhshai ◽

Falk Roeder ◽

Christof Birkenmaier ◽

Andrea Baur-Melnyk ◽

...

Keyword(s):

Bone Tumors ◽

Tumor Resection ◽

Clinical Results ◽

Fibular Graft ◽

Microvascular Anastomosis ◽

First Case ◽

Common Location ◽

Skeletal Defects ◽

Common Diagnosis

Abstract Background Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. Results the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. Conclusions the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

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Diffusion-weighted Magnetic Resonance Imaging in the Diagnosis of Bone Tumors: Preliminary Results

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.124094 ◽

2013 ◽

Vol 3 ◽

pp. 63 ◽

Cited By ~ 15

Author(s):

Yeliz Pekcevik ◽

Mehmet Onur Kahya ◽

Ahmet Kaya

Keyword(s):

Magnetic Resonance ◽

Bone Tumors ◽

Malignant Tumors ◽

Receiver Operating Curve ◽

Benign Tumors ◽

Single Shot ◽

Malignant Bone Tumors ◽

Diffusion Weighted ◽

Adc Values ◽

The Mean

Objective: The study aims to determine whether apparent diffusion coefficient (ADC) can help differentiate benign and malignant bone tumors. Materials and Methods: From January 2012 to February 2013, we prospectively included 26 patients. Of these 15 patients were male and 11 were female; ranging in age from 8 to 76 years (mean age, 34.5 years). Diffusion-weighted magnetic resonance (MR) imaging was obtained with a single-shot echo-planar imaging sequence using a 1.5T MR scanner. We grouped malignant lesions as primary, secondary, and primary tumor with chondroid matrix. The minimum ADC was measured in the tumors and mean minimum ADC values were selected for statistical analysis. ADC values were compared between malignant and benign tumors using the Mann-Whitney U-test and receiver operating curve analysis were done to determine optimal cut-off values. Results: The mean ADC values from the area with lowest ADC values of benign and malignant tumors were 1.99 ± 0.57 × 10−3 mm2/s and 1.02 ± 1.0 × 10−3 mm2/s, respectively. The mean minimum ADC values of benign and malignant tumors were statistically different (P = 0.029). With cut-off value of 1.37 (10−3 mm2/s), sensitivity was 77.8% and specificity was 82.4%, for distinguishing benign and malignant lesion. Benign and secondary malignant tumors showed statistically significant difference (P = 0.002). There was some overlap in ADC values between benign and malignant tumors. The mean minimum ADC values of benign and malignant chondroid tumors were high. Giant cell tumor, non-ossifying fibroma and fibrous dysplasia showed lower ADC values. Conclusion: Although there is some overlap, ADC values of benign and malignant bone tumors seem to be different. Further studies with larger patient groups are needed to find an optimal cut-off ADC value.

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Novel 3D-printed prosthetic composite for reconstruction of massive bone defects in lower extremities after malignant tumor resection

Journal of Bone Oncology ◽

10.1016/j.jbo.2019.100220 ◽

2019 ◽

Vol 16 ◽

pp. 100220 ◽

Cited By ~ 2

Author(s):

Yajie Lu ◽

Guojing Chen ◽

Zuoyao Long ◽

Minghui Li ◽

Chuanlei Ji ◽

...

Keyword(s):

Malignant Tumor ◽

Tumor Resection ◽

Lower Extremities ◽

Bone Defects ◽

3D Printed ◽

Massive Bone

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Risk factors and outcomes for failure of biological reconstruction after resection of primary malignant bone tumors in the extremities

Scientific Reports ◽

10.1038/s41598-021-00092-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Taweechok Wisanuyotin ◽

Permsak Paholpak ◽

Winai Sirichativapee ◽

Weerachai Kosuwon

Keyword(s):

Risk Factors ◽

Functional Outcomes ◽

Bone Tumors ◽

Tumor Resection ◽

Tumor Location ◽

Complication Rates ◽

Malignant Bone Tumors ◽

Biological Reconstruction ◽

Significant Difference ◽

Autograft Group

AbstractBiological reconstruction is widely used to reconstruct bone defects after resection of bone tumors in the extremities. This study aimed to identify risk factors for failure and to compare outcomes of the allograft, nonvascularized autograft, and recycled frozen autograft reconstruction after resection of primary malignant bone tumors in the extremities. A retrospective study was performed at a single center between January 1994 and December 2017. Ninety patients with primary malignant bone tumors of the extremities were treated with tumor resection and reconstruction using one of three bone graft methods: nonvascularized autograft (n = 27), allograft (n = 34), and recycled frozen autograft (n = 29). The median time for follow-up was 59.2 months (range 24–240.6 months). Overall failure of biological reconstruction occurred in 53 of 90 patients (58.9%). The allograft group had the highest complication rates (n = 21, 61.8%), followed by the recycled frozen autograft (n = 17, 58.6%) and nonvascularized autograft (n = 15, 55. 6%) groups. There was no statistically significant difference among these three groups (p = 0.89). The mean MSTS score was 22.6 ± 3.4 in the nonvascularized autograft group, 23.4 ± 2.6 in the allograft group, and 24.1 ± 3.3 in the recycled frozen autograft group. There was no significant difference among the groups (p = 0.24). After bivariate and multivariable analyses, patient age, sex, tumor location, graft length, methods, and type of reconstruction had no effects on the failure of biological reconstruction. Biological reconstruction using allograft, nonvascularized autograft, and recycled frozen autograft provide favorable functional outcomes despite high complication rates. This comparative study found no significant difference in functional outcomes or complication rates among the different types of reconstruction.

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Isolated chemoperfusion of the lung and pleura as a method of treatment in children with common forms of solid bone tumors

Russian Journal of Pediatric Hematology and Oncology ◽

10.21682/2311-1267-2019-6-1-40-47 ◽

2019 ◽

Vol 6 (1) ◽

pp. 40-47

Author(s):

E. V. Levchenko ◽

E. D. Gumbatova ◽

S. A. Kuleva ◽

K. Yu. Senchik ◽

O. Yu. Mamontov ◽

...

Keyword(s):

Overall Survival ◽

Bone Tumors ◽

Pleural Cavity ◽

Malignant Tumors ◽

Treatment Options ◽

Systemic Exposure ◽

Parietal Pleura ◽

Malignant Bone Tumors ◽

Surgical Interventions ◽

Isolated Lung

Introduction. Therapy of malignant tumors is one of the most important problems of modern pediatric oncology. The presence of distant metastases is considered as the main sign of generalization of the tumor process. In order to improve the results of treatment of these patients, we proposed to supplement cytoreductive surgery with intraoperative isolated chemoperfusion of the lung and/or pleura with cytostatic. The purpose of the study is to determine the effectiveness of metastasectomy combined with isolated lung/pleura chemoperfusion (ILCP/PCP) under conditions of hyperoxia in children. Materials and methods. For 10 years of research (2008–2018) on the basis of the N.N. Petrov National Medical Research Center of Oncology produced 45 ILCP and PCP in 30 patients with intrapulmonary and intrapleural metastases of various malignant bone tumors. The ILCP method is a surgical procedure, during which the lung is temporarily switched off from the circulation and perfused with modified saline containing high concentrations of an antitumor drug (melphalan or cisplatin), which allows delivery of high doses of cytostatics while avoiding systemic exposure to the drug. In cases of detection of metastatic lesions of the parietal pleura after metastasectomy, PCP was performed, consisting in drainage of the pleural cavity and intraoperatively conducting, after suturing the surgical wound, hyperthermic (42 o С) chemoperfusion of the pleural cavity with a cisplatin solution for 2 hours. Results. In children with malignant bone tumors, 37 isolated chemoperfusions with cisplatin and 8 with melphalan were performed. In 27 patients, 36 ILCP were performed, in 7 patients – 9 PCP. Nine (20 %) patients underwent bilateral perfusion with an interval from 1.5 to 31 months. There were no lethal outcomes during operations and in the postoperative period. The average duration of surgical interventions was 270 ± 90 (120–520) minutes. The number of remote foci – from 1 to 56 (average value – 9). The average blood loss was 300 ± 200 (150–1000) ml. The mean follow-up was 45 months; median overall survival – 38 months; 3-year overall survival – 65.5 ± 9.4 %. Survival without progression – 40.5 ± 10.5 % (n = 30). Conclusions. ILCP/PCP with cytostatics is a method of complex therapy that can improve the quality and increase the life expectancy of patients, especially with the exhausted possibility of other treatment options.

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Technique and Results after Immediate Orthotopic Replantation of Extracorporeally Irradiated Tumor Bone Autografts with and without Fibular Augmentation in Extremity Tumors

10.21203/rs.3.rs-257593/v1 ◽

2021 ◽

Author(s):

Alexander Klein ◽

Yasmin Bakhshai ◽

Falk Roeder ◽

Christof Birkenmaier ◽

Andrea Baur-Melnyk ◽

...

Keyword(s):

Bone Tumors ◽

Tumor Resection ◽

Clinical Results ◽

Bone Defects ◽

Fibular Graft ◽

Microvascular Anastomosis ◽

Common Location ◽

Common Diagnosis ◽

Bone Autograft

Abstract Background: the reconstruction of the bone defects after the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of an autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods and patients: we were able to include 21 patients with 22 reconstructions. In all cases, the bone tumor was resected with wide margins and irradiated with 300 Gy. The autograft was orthotopically replanted and stabilized by means of osteosynthesis implants. 15 patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a local pedicled fibular interposition. Results: the most common diagnosis was a Ewing-sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months. During follow-up, 59% of patients underwent an average of 2.54 revision surgeries, with the most common reason being pseudarthrosis (6 cases). Complete bony integration of the irradiated autografts was achieved in 81.8% of cases after 13.6 months on average. In case of successful reintegration the autograft was shorter (n.s.). Fibular augmentation with or without microvascular anastomosis/pedicled blood supply did not correlate with the pseudarthrosis rate.Conclusions: the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors maintainable joints. However, these patients should be ready to accept longer treatment periods.

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Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications

Journal of Surgical Oncology ◽

10.1002/jso.25032 ◽

2018 ◽

Vol 117 (7) ◽

pp. 1432-1439 ◽

Cited By ~ 6

Author(s):

Mark J. Landau ◽

Ido Badash ◽

Christine Yin ◽

Ram K. Alluri ◽

Ketan M. Patel

Keyword(s):

Systematic Review ◽

Upper Extremity ◽

Operative Treatment ◽

Bone Tumors ◽

Malignant Bone Tumors ◽

Vascularized Fibula

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Relationship of the content of vitamin D and melatonin in blood serum and pineal gland calcifications in patients with malignant bone tumors

French-Ukrainian Journal of Chemistry ◽

10.17721/fujcv9i1p63-69 ◽

2021 ◽

Vol 9 (1) ◽

pp. 63-69

Author(s):

Oleg Drobotun ◽

Mykola Kolotilov ◽

Mykola Safonov

Keyword(s):

Vitamin D ◽

Pineal Gland ◽

Blood Serum ◽

Vitamin D Deficiency ◽

Bone Tumors ◽

Malignant Tumors ◽

Lower Extremities ◽

Malignant Bone Tumors ◽

Relationship Of ◽

The Relationship

The aim of the study was to investigate the relationship between the vitamin D content, melatonin and the characteristics of pineal gland calcifications in patients with malignant tumors of the bones of the lower extremities. Vitamin D deficiency and pineal gland calcifications are observed in almost 100 % of patients with malignant tumors of the lower extremities’ bones. The high heterogeneity of calcifications and its dynamics during the treatment of patients may indicate the processes of their litholysis and dissolution.

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