title: Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients.
abstract: BACKGROUND
  En bloc resection, extracorporeal irradiation (ECI) and reimplantation have been used selectively at our centers as part of limb preservation surgery of malignant bone tumors since 1996. We report the long-term oncological outcomes.
  
  
  METHODS
  One hundred one patients were treated with ECI at two Australian centers between 1996 and 2011. A single dose of 50 Gy was delivered to the resected bone segments. The irradiated bones were reimplanted immediately as a biological graft. Patients were treated with chemotherapy as per standard protocol. The three main histological diagnoses were Ewing's sarcoma (35), osteosarcoma (37) and chondrosarcoma (20). There were nine patients with a range of different histologies.
  
  
  RESULTS
  There was one local recurrence (2.86%) in Ewing's sarcoma and the 5-year cumulative overall survival was 81.9%. There was no local recurrence in osteosarcoma and five distant recurrences. The 5-year cumulative overall survival was 85.7%. The local recurrence rate was 20% (4 of 20) in chondrosarcoma, and the 5-year cumulative overall survival was 80.8%. Limb preservation was achieved in 97 patients. For the 64 patients with disease in the pelvis or lower limb, 53 (82.3%) could walk without aids at the time of last follow-up.
  
  
  CONCLUSIONS
  This large series of ECI shows an excellent long-term local control. It is a good alternative reconstruction method in selected patients. The overall survival is comparable to other published series.
authors.affiliation: Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney; Sydney Medical School, The University of Sydney, Sydney. Electronic address: angela.hong@sydney.edu.au.
authors.forename: A M
authors.initials: AM
authors.lastname: Hong
authors.affiliation: Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney.
authors.forename: S
authors.initials: S
authors.lastname: Millington
authors.affiliation: Department of Radiation Oncology, Westmead Hospital, Sydney.
authors.forename: V
authors.initials: V
authors.lastname: Ahern
authors.affiliation: Department of Paediatric Oncology, The Children's Hospital at Westmead, Sydney.
authors.forename: G
authors.initials: G
authors.lastname: McCowage
authors.affiliation: Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney.
authors.forename: R
authors.initials: R
authors.lastname: Boyle
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney; Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Tattersall
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney.
authors.forename: L
authors.initials: L
authors.lastname: Haydu
authors.affiliation: Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney.
authors.forename: P D
authors.initials: PD
authors.lastname: Stalley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D001842:Bone and Bones / Q000473:pathology / Q000528:radiation effects; D002648:Child; D002675:Child, Preschool; D002813:Chondrosarcoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D012516:Osteosarcoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ewing's sarcoma; chondrosarcoma; extracorporeal; osteosarcoma; radiation; sarcoma