Publication de Nicole Delepine : Acrylic reconstruction after en bloc resection of iliac bone for sarcoma

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Publié sur : Publication Powerpoint Delepine - 2010
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Acrylic reconstruction after en bloc resection of iliac bone for sarcoma
F. Delepine, G. Delepine, Nicole Delepine and Coll

Acrylic reconstruction after en bloc resection of iliac bone for sarcoma


iliac bone for sarcoma


Introduction


Location on iliac bone

Location on iliac bone accounts for 20% to 30% of sarcoma. Gold standard of local treatment is wide resection but till now few papers have tried to evaluate the long term results of reconstructive procedures when chemotherapy and /or radiotherapy are used.

Patients


age patients

44 patients (25 males and 19 females aged 9 to 66 years) with bone sarcoma of innominate bone in Zone 1, 2 or 4 (without involvement of acetabulum) were treated and/or followed up by the same team in 23 years.

Initial staging


bone technetium scanbone technetium scan

Preoperative screening of patients included standard X rays, CT and bone technetium scan in all cases and MRI in 15 cases.
Diagnosis was made by open biopsy except for 4 cases of chondrosarcoma for these preoperative screening was sufficient (postoperative histological examination confirmed diagnosis).

Histology was:


chondrosarcomaEwing osteosarcoma


Location of tumors


location of tumorsTumors involved :
- zones I : 8
- zone II : 0
- zones III : 30
- zones I+IV: 6


Resections


resections* 44 en bloc resections:
- All limb sparing
- 39 for localized tumors
- 5 for metastatic lesions

* MARGINS
- 4 extratumoral ...
- 40 contaminated ...


The resection respected the pelvic ring continuity in 23 cases


resections


resections


resections


The resection interrupted the pelvic continuity in 21 cases


resections


resections


resections


resections


Reconstruction Technic


ReconstructionAfter resection screws are inserted in both sides of remaining bones.
Then antibiotic loaded cement is moulded all around the screws.


Method


method

Surrounding muscles are then fixed on the cement with wires.

method

In some favorable cases (when iliac crest and gluteus muscles are free of tumour) the resection is performed through a pelvic approach and iliac remains with the gluteus insertions. The iliac crest can be fixed with screws into the cement.

Oncologic results


With a median follow-up of 15 years (minimal 2 - maximal 22):

- 11 patients died from disease after local recurrence (6) and / or metastases (7). One disease free survivor has been lost for follow after 3 years, 1 patient is alive with disease.

- The 31 others are disease free survivors
In these patients, the prognosis was directly correlated with the histological grading :
low grade chondrosarcoma have a 85% DFS


Oncologic results in high grade tumours


high grade tumours
Ewing. Girl of 13 with bony met on the femoral neck. Chemotherapy and resection of primary and met.
FU 13 years. DFS

Prognosis correlated with efficacy of the chemotherapy protocol.

For primary metastatic patients when chemotherapy suboptimal or margins contaminated :

- prognosis dismal

With our most effective protocols and free margins, metastatic lesions did not affect the disease free survival of our patients.



Orthopaedic results


Weight bearing was immediate in all cases.

We observed 3 deep infections:
- 2 compelled to make resection of the cement
-and 2 late mobilisations of cement.

In all other patients, the reconstructive procedure gave a good and stable functional result even in very long follow up.


Long term follow up


chondrosarcoma

Huge chondrosarcoma grade 2. 15 y FU. CDSF. Excellent result. No loosening

chondrosarcoma

Ewing of zone 3. 14 years FU. Excellent function. No pain. Professional rider.


follow upfollow up

Chondrosarcoma grade 1. 19 y FU. CDSF.
Excellent result.
No loosening


Long term stability


chondrosarcoma

Chondrosarcoma. 19 y FU. Excellent result.

stability

Ewing 20 years FU No pain No loosening Excellent function

high grade tumoursstability

Ewing. 21 years FU. No loosening. Normal function

Conclusion


Acrylic reconstruction is an easy and reliable reconstructive procedure after en bloc resection of iliac bone for malignant tumours in zone 1, 2 or 4.

It is more reliable than bone graft when chemotherapy or radiotherapy are necessary.




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