Aim. To review the first 50 cases, looking at survivorship of the irradiated autograft, complications and functional outcomes in a wide range of bony malignancies and anatomical locations. Methods. 50 patients underwent en-bloc resection, extracorporeal irradiation with 50 Gy, and re-implantation for limb salvage between August 1996 and June 2003. Case notes and patients were reviewed. Results. Mean follow up was 101 months (70-152). 39 (78%) patients are alive and disease free, 11 (22%) have died, 8 of which had high grade pelvic malignancy. Local recurrence occurred in 6 cases (12%). 4 pelvic chondrosarcomas, one pelvic Ewings sarcoma and one soft tissue recurrence in a high grade proximal humeral osteosarcoma. Graft failure was seen in 6 cases (12%), as defined by Mankin. Three were due to graft resorption; one proximal humerus and two acetabular. Two were in patients with recurrent disease, one requiring a shoulder disarticulation and one who died from pelvic disease. One patient fractured through a femoral graft after a mechanical fall. 10 (20%) of patients required grafting of the non union site +/− revision fixation, there were 3 (6%) superficial infections with no deep infections. Of the 38 disease free survivors, the Mankin score was excellent in 17, good 10, fair 9 and two failures. The mean Musculoskeletal Tumour Society Score was 82 and Toronto Extremity Salvage Score 84. Conclusions. This method of limb salvage provides a biological reconstruction and compares favourably with the use of massive allografts and massive endoprostheses, with regard to complication rates and functional outcomes

A rare case of malignant transformation of fibrous dysplasia to chondrosarcoma involving the pelvis, treated by hemipelvectomy, was described by our team in a published case report. Twenty-four years later, the patient remains recurrence-free, with a good functional outcome that allows him to be independent in everyday activities and work in full time employment. Functional outcome following hemipelvectomy for pelvic malignancy is an evolving topic, as improved imaging and surgical techniques result in earlier diagnosis and a better overall prognosis. Sarcomas involving the pelvis still represent a challenging topic for surgeons. During the last twenty-four years, there have been some advances in the limb- salvage treatment of pelvic tumours. An internal hemipelvectomy is currently considered to be a reasonable treatment option, with good functional outcomes and achievement of satisfactory tumour clearance margins, in well- selected cases. In all cases however, the main focus should be in the adequate resection of the lesion, followed by restoration of maintenance of stability. We report a fascinating case of a patient who underwent internal hemipelvectomy without reconstruction for chondrosarcomatous transformation of pelvic fibrous dysplasia, with emphasis on the clear surgical resection margins and disease-free status of the patient and satisfactory functional outcome. We support that internal hemipelvectomy is an acceptable treatment option in well- selected cases and can achieve clear tumour resection margins, resulting in long term disease-free results, and a good limb- salvage functional outcome. We believe that joint stability in this patient is mainly a result of preservation of the adductor muscle group, which prevents the hip joint from upward migration and allows the patient to use his left leg for walking

Objectives

We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model.

The February 2013 Oncology Roundup³⁶⁰ looks at: proximal fibular tumours; radiotherapy-induced chondrosarcoma; mega-prosthesis; CRP predictions of sarcoma survival; predicting survival in metastatic disease; MRI for recurrence in osteoid osteoma; and a sarcoma refresher