Combination of bone cement filling and plate internal fixation with limb salvage is used for metastatic malignant bone tumors

doi:10.3969/j.issn.2095-4344.2013.34.003

Abstract

Abstract:

BACKGROUND: Currently, limb salvage therapy has become the standard treatment of malignant bone tumors way, but improper treatments will result in tumor recurrence, secondary infection, internal fixation or prosthesis loosening.
OBJECTIVE: Based on the traditional surgical principle for metastatic bone tumors of the limbs, this study designed a user-friendly, individualized, simplistic palliative treatment regimen from the actual conditions of patients to observe the reasonability, clinical efficacy and prognosis of bone cement filling combined with internal fixation in the treatment of metastatic malignant bone tumors.
METHODS: Thirty-one patients with metastatic malignant bone tumors who required salvage treatment were screened from the Department of Orthopedics, the 421 Hospital of Chinese PLA, and their clinical data were retrospectively analyzed. All the 31 patients were divided into two groups: tumor removal+internal fixation group (non-chemoradiotherapy group, n=11) treated with bone cement filling plus plate internal fixation (palliative treatment); tumor removal+internal fixation+chemoradiotherapy group (chemoradiotherapy group, n=20), treated with radiotherapy before internal fixation plus plate internal fixation with limb salvage. The follow-up period was 4-38 months, averagely 18 months.
RESULTS AND CONCLUSION: The follow-up results showed that in the non-chemoradiotherapy group, all the 11 patients survived, who could live independently and have good motor functions; in the chemoradiotherapy group, 17 of the 20 patients survived and the rest three patients died of tumor metastasis, their poor conditions and complications at 9 and 13 months after internal fixation. In patients undergoing tumor removal+plate internal fixation with limb salvage, the integrated scores for nerve and motor functions were increased by more than level 1. These findings confirm that a simple palliative therapy of bone cement filling and internal fixation without chemoradiotherapy is better for metastatic malignant bone tumors patients who require limb salvage.

Key words: biomaterials, tissue-engineered bone materials, bone tumor, bone cement, internal fixation, metastasis, malignant tumor, limb salvage treatment, radiotherapy, chemotherapy, pathological fracture, retrospective analysis

CLC Number:

R318

Yang Jun, Yu Bin, Guo Xin-hui, Yang Peng, Zhang Kai-rui, Zhang Sheng, Cai Wei-bin, Ku Jian-bin, Tian Ling-yan. Combination of bone cement filling and plate internal fixation with limb salvage is used for metastatic malignant bone tumors[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(34): 6073-6082.

Figures/Tables 6

References

[1]Xu ST, Ge BF, Xu YK. Shiyong Gukexue, 3rd. Beijing: People’s Military Publishing House. 2006.

[2]Rougraff BT, Kneisel JS, Simon MA, et al. Skeletal metastases of nknown origin: a prospective study of a diagnostic strategy. Bone Joint Surg Am. 1993;75(9): 1276-1281.

[3]Mankin HJ, Lange TA, Spanier SS, et al. The hazards of biopsy in patients with malignant primary bone and soft tissue tumors. J Bone Joint Surg Am. 1982;64(8): 1121- 1127.

[4]Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80(8 Suppl):1588-1594.

[5]Wedin R, Bauer HC, Wersall P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop Relat Res. 1999;(358):128-139.

[6]Deng ZC, Chen ZG, Zahng TH, et al. Clinical analysis of the pathological fracture in femur. Zhongguo Zonghe Linchuang. 2000;16(11):828-829.

[7]Salmon JM, Kilpatrick SE. Pathology of skeletal metastases. Orthop Clin North Am. 2000;31(4):537-544.

[8]Sampo M, Koivikko M, Taskinen M, et al．Incidence, epidemiology and treatment results of osteosarcoma in Finland-a nationwide populationbased study. Acta Oncol. 2011;50(8):1206-1214．

[9]Kabukcuoglu Y, Grimer RJ, Tillman RM, et al. Endoprosthetic replacement for primary malignant tumor of the proximal femur. Clin Orthop Relat Res. 1999;(358): 8-14.

[10]Dedkov AG. Treatment outcome of patients with bone tumors after limb salvage surgery. Lik Sprava. 2010; (3-4):46-56.

[11]Graci C, Maccauro G, Muratori F, et al. Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review. Int J Immunopathol Pharmacol. 2010;23(4):1005-1013.

[12]Jeys LM, Grimer RJ, Carter SR, et al. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop. 2003;27(3):160-163.

[13]Chandrasekar CR, Grimer RJ, Carter SR, et al. Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg (Br). 2009;91(1):108-112.

[14]State Council of the People’s Republic of China. Administrative Regulations on Medical Institution. 1994-09-01.

[15]Wan R, Zhang WB. Treatment of metastatic bone tumor limb surgical principles. Shiyong Zhongliu Zazhi. 2008;23(4):297-300.

[16]Mirels H, Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop. 1989;(249):256-264.

[17]Ye CM, Yang DS. Operation treatment of metastatic bone tumor. Shiyong Zhongliu Zazhi. 2006;21(1):12-14.

[18]Ruxianai Guzhuanyi and Guxiangguan Jibing Linchuangzhenliao Zhuanjiazu. Consensus and bone metastasis of breast cancer related diseases clinical diagnosis and treatment expert. Zhonghua Zhongliu Zazhi. 2009;31(2):156-159.

[19]Liu YC, Hu YC, Xia Q, et al. Management of tumorous long bone pathological fractures: Allogeneic bone reconstruction, graft reconstruction or prosthesis replacement? Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2010; (14-22):4139-4133.

[20]Bacci G, Ferrari S, Mercuri M, et al. Predictive factors for local recurrence in osteosarcoma: 540 patients with extremity tumors followed for minimum 2.5 years after neoadjuvant chemotherapy. Acta Orthop Scand. 1998; 69(3):230-236.

[21]Scully SP, Ghert MA, Zurakowski D, et al. Pathologic fracture in osteosarcoma: prognostic importance and treatment implications. J Bone Joint Surg (Am). 2002; 84-A(1):49-57.

[22]Gupta GR, Yasko AW, Lewis VO, et al．Risk of local recurrence after deltoid-sparing resection for osteosarcoma of the proximal humerus. Cancer. 2009;115(16):3767-3773.

[23]Kim HJ, Chalmers PN, Morris CD. Pediatric osteogenic sarcoma. Curr Opin Pediatr. 2010;22(1):61-66．

[24]Poffyn B, Sys G, Van Maele G, et al．Radiographic analysis of extracorporeally irradiated autografts．Skeletal radiology. 2010;39(10):999-1008．

[25]Zhu B. Limb salvage operation treatment of malignant bone tumor. Shiyong Gukexue. 2007;8(3):1553-1535．

[26]Jing X, Wu HS, Zhou WJ. Progress in the study of pathogenesis of metastatic tumor of bone. Zhonghua Guke Zazhi. 2002;22(6):377-379.

[27]Guo W, Guo Y, Feng CH. Therapeutic mechanism of bisphosphonates for metastatic tumor of bone. Zhonghua Guke Zazhi. 2003;23(1):36-38.

[28]Mundy GR. Mechanisms of bone metastasis. Cancer. 1997;80(8 Suppl):1546-1556.

[29]Frassica FJ, McCarthy EF. Metastatic carcinoma in bone. In pathology of bone and joint disorders. Philadelphia: WB Saunders. 1998.

[30]Basset P, Bellocq JP, Wolf C, et al. A novel metalloprpteinase gene specifically expressed in stromal cells of breast carcinomas. Nature. 1990;348(6303): 699-704.

[31]Yang RL, Xu WP, Guo W, et al. Surgery of metastases in limbs of 61 patients. Zhongguo Guzhongliu Gubing. 2004; (6):3330-3341.

[32]Tang XD, Guo W, Yang RL, et al. Segmental allograft reconstruction in skeletal defect after limb tumor resection. Zhongguo Xiufu Chongjian Waike Zazhi. 2006;(10): 985-988.

[33]Li DS, Zhang ZY, Huang MY, et al. Methods and opportunity of operation for the malignant tumor intercurrent fracture of extremity. Zhongguo Jiaoxing Waike Zazhi. 2006;(5): 331-333.

[34]Gao ST, Li DS, Zhang ZY, et al. Operation modes for proximal femur tumor with pathological fracture. Zhongguo Jiaoxing Waike Zazhi. 2009;(7):488-490.

[35]Sun Q, Zhao DW. Treatment of metastatic carcinoma of extremities with pathological fracture by combination of percutaneous cementaion and external fixation. Zhongguo Guzhongliu Gubing. 2005;(3):133-134.

[36]Durr HR, Maier M, Pfaler M, et al. Surgical treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop. 1999;(367):283-290.

[37]Raffi S, Avedian, Rex C, et al Peabody Multiplanar osteotomy with limited wide margins: a tissue preserving surgical technique for high-grade bone sarcomas. Clin Orthop Relat Res. 2010;468(10):2754-2764.

[38]Fraquet N, Faizon G, Rosset P, et al. Long bones giant cells tumors: treatment by curretage and cavity filling cementation. Orthop Traumatol Surg Res. 2009;95(6): 402-406.

[39]Liu J, Yang S, Li L. Department of Orthopedics Diagnosis Classification And Function Evaluation, 1st. Beijing: People’s Military Publishing House. 2012.