Original Research Paper

Extra Corporeal Irradiation And Surgical Reinforcement In Primary Malignant Bone Tumors: A Poor Man's Biological Prosthesis

  Abstract :

Limb preserving surgeries are established as oncologically safe and standard of care in the management of primary malignant bone tumors. Surgical resection, extracorporeal irradiation and surgical reimplatation is one among the limb sparing techniques. In our institute, we adopted this method in 9 patients and analysed their oncological outcome.Materials and MethodsBetween 2019 to 2022 Nine patients diagnosed with primary bone tumors after appropriate neoadjuvant chemotherapy, underwent surgical resection and extracorporeal irradiation and surgical fixation. 6 were men and 3 women. 6 patients were diagnosed with ewings sarcoma and three with Osteogenic sarcoma. The median age was 14years (range 8-20 years). The treated bones were femur (n=4), tibia (n=2), humerus (n=2), iliac bone with acetabulum (n=1). After informed consent and appropriate investigations, patients underwent wide local excision. The resected bone was irradiated with single dose of 50Gy was re-implanted and stabilised with screws and plates. Patients were mobilised with appropriate mechanical aids and referred for completion of chemotherapy. All were followed-up with appropriate imaging. Out of the 9 patients, 1 patient with osteosarcoma after six month of disease free interval developed local recurrence along with distant metastasis. One patient with Ewings sarcoma had non-union, however the patient was still on adjuvant chemotherapy. The remaining seven patients remained disease free till the last follow-up. The mean musculoskeletal tumour society scoring system (MSTSS) was 3 (range 1-4).ConclusionIn government aided centres where majority of patients belong to lower socio-economic class, unsupported by health insurance, limb preservation by extracorporeal irradiation can be an alternative modality. ECRT would serve as best size matched, poormans biological prosthesis, which is less expensive, readily available and yet maintaining the purpose of limb function.

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