title: Role of extracorporeal irradiation in malignant bone tumors.
abstract: OBJECTIVE
  Extracorporeal irradiation (ECI) is relatively a rare method used in the management of malignant bone tumors (MBT). It consists of en-bloc removal of the tumor bearing bone segment, removal of the tumor from the bone, irradiation, and re-implantation back in the body. We report our preliminary experience of using ECI for management of MBT.
  
  
  METHODS
  From year 2009 to 2010, 14 patients with primary MBT were enrolled into this study. The eligibility criteria included histopathological proof of malignancy, no evidence of distant metastases, and suitability for limb preservation therapy. Surgery was performed about 4 weeks after completion of neoadjuvant chemotherapy. The affected bone segment was resected, irradiated extracorporeally with a dose of 50 Gy and reimplanted. Local control, complications and short-term survival were studied. Functional outcome was assessed by Musculoskeletal Tumor Society (MSTS) scoring system.
  
  
  RESULTS
  There were 10 males and four females with median age of 14 years. Histopthologically, nine patients had osteosarcoma (OS) and five had Ewing's sarcoma family of tumors (ESFT). Distribution of primary site was as follows: Femur eight patients, tibia five patients and humerus one patient. At a median follow-up was 22 months, three patients (two OS, one ESFT) had local recurrence. Two patients (14%) developed wound infection in the perioperative period. The 2 year local recurrence free survival was 73% and mean MSTS score was 88.
  
  
  CONCLUSIONS
  Results of our study suggest that ECI is technically feasible in the management of MBT and provides decent local control and short-term survival rates.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: D N
authors.initials: DN
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Rastogi
authors.forename: S
authors.initials: S
authors.lastname: Bakhshi
authors.forename: G K
authors.initials: GK
authors.lastname: Rath
authors.forename: P K
authors.initials: PK
authors.lastname: Julka
authors.forename: M A
authors.initials: MA
authors.lastname: Laviraj
authors.forename: S A
authors.initials: SA
authors.lastname: Khan
authors.forename: A
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D012512:Sarcoma, Ewing / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery