Abstract
We have used extracorporeal irradiation as part of the treatment of primary bone tumours since 1996. It is a technique that preserves bone stock, with no allograft cost, is tailor made for the individual and can protect the epiphyseal plates in the immature skeleton.
All cases are biopsied, staged and if appropriate undergo pre-operative chemotherapy. The resected specimen is wrapped in sterile drapes, sealed and then irradiated in either the linear accelerator or a blood product irradiator. The mid-plane dose delivered to the specimens was 50 Gy. The specimen is then reimplanted using varied methods. Post-operative chemotherapy is given if indicated, and the patients have 6 weeks of antibiotics. Regular review is undertaken in the outpatients. We individually reviewed all the patients, examined them and scored their functional results according to the Mankin and Enneking Systems. The pelvic/proximal femur patients also had a Harris Hip Score recorded.
There were 31 cases all over 6 months from surgery with an average follow up of 24 months. Mean age at diagnosis was 24.9 years (range 3 to 66), in 15 males and 16 females. Pathology included 10 osteosarcomas, 13 Ewing’s and 8 chondrosarcomas. Affected bones were 4 proximal humeri, 14 hemipelvises, 12 femurs and 1 tibia. Reconstruction varied from autograft alone, to autograft with a prosthesis, intramedullary nail or blade plate. 10 patients had supplementary vascularized fibula grafts and 2 pedicle flaps. There have been 4 deaths of disease, 2 alive with disease and 25 currently disease free. The Enneking scores averaged 70%, the Harris Hip Scores averaged 74 in the pelvic reconstructions and 92 in the proximal femurs.
The abstracts were prepared by Mr Richard Buxton. Correspondence should be addressed to him at Bankton Cottage, 21 Bankton Park, Kingskettle, Cupar, Fife KY15 7PY, United Kingdom
