ONCOLOGICAL AND FUNCTIONAL OUTCOME USING EXTRACORPOREAL IRRADIATION IN LIMB-PRESERVING SURGERY IN THE MANAGEMENT OF BONE AND SOFT-TISSUE SARCOMA
Notice bibliographique
Résumé
Biological reconstruction with extracorporeal irradiation and reimplantation is an alternative to endoprosthetic reconstruction following osseous resection of extremity bone sarcomas and soft tissue sarcomas (STS). This method involves en bloc resection of the tumour, irradiation of the bone and re-implantation. Limb salvage surgery with autologous bone graft is reported to have better functional outcome due to its precise anatomical fit. This study reports the oncological and functional outcomes of patients who had extracorporeal irradiation (ECI) and reimplantation in our centre. ECI Technique: Following wide resection, the bone segment was wrapped in sterile plastic bags and towels and placed in a box surrounded by water equivalent materials. The box was then irradiated with parallel opposed fields using 10 megavolt (MV) photons to a dose of 50Gy in one fraction. The resected bone was then returned back to the operating room and re-implanted. We reported the demographic information and summary statistics of all patients undergoing this procedure at our institution. Four patients were treated with ECI and biological reconstruction from July 2021 to October 2023. Three patients were female and one was male. Three patients had high grade conventional osteosarcoma (age range 10 – 28), and one had a high grade myxofibrosarcoma with cortical involvement of the distal tibia (age 70). All patients had lower limb disease including proximal and distal femur and proximal and distal tibia. Three patients had metadiaphyseal resections and one patient had osteoarticular resection. Patients with high grade conventional osteosarcoma had pre-operative chemotherapy as per the Children's Oncology Group AOST0331 protocol and the patient with myxofibrosarcoma had pre-operative radiotherapy to the primary STS prior to resection. One patient with high grade osteosarcoma had surgery one month ago, and thus will be excluded from further analysis due to lack of follow up data. At a median follow up time of 19 months (range 17- 27), the remaining three patients are alive and free from distant metastatic disease. No patients developed local recurrence after ECI. One patient had union at the osteotomy site at three months but then required a subsequent bone grafting procedure due to a non-union which happened 17 months after the initial surgery. Another patient had union at the osteotomy site uneventually at 13 months. One patient's irradiated autograft developed an infection and had to be removed and was replaced with a PROSTALAC implant. Adjuvant Doxorubicin chemotherapy was given without any unforeseen delay post ECI for two patients, at 16 and 21 days after surgery. Neither patient developed any acute radiotherapy toxicities. All patients had good functional outcomes and able to walk unaided at last follow up. From our experience, ECI offers excellent long term local control and is a good alternative to using endoprosthesis in patients with primary bone tumour and STS with bone involvement. Doxorubicin chemotherapy can be safely given within 3 weeks after ECI with no added risk of radiotherapy complications. Non-union and infection of the implanted autograft are possible complications post ECI.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».