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Intraoperative extrakorporale Irradiation und Replantation (IEIR) in der lokalen Behandlung primär maligner Knochentumoren

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Zusammenfassung

Bei 13 Patienten mit primär malignen Knochentumoren (10 Tumoren der Ewing-Sarkomgruppe, 1 parossales Osteosarkoma, 1 Adamantinomrezidiv, 1 malignes Hämangioperizytom) wurde die lokale Therapie als intraoperative extrakorporale Bestrahlung und Replantation (IEIR) des betroffenen knöchernen Segments durchgeführt (5 Tibia, 2 Femur, 6 Becken); 9 von 13 Patienten (69%) sind zum Zeitpunkt der Nachuntersuchung am Leben (5 CDF, 4 AWMtreated); 4 Patienten sind verstorben (DOD). Während des bisherigen Nachbeobachtungszeitraums von 32 (6–57) Monaten wurden Lokalrezidive im extrakorporal bestrahlten Replantat nicht beobachtet. Die Komplikationsrate in dem beobachteten Kollektiv war sehr hoch (18 Komplikationen bei 11 der 13 Patienten, davon in 6 Fällen V° nach Ruggieri mit Verlust des Replantats).

Die typische Komplikation ist die schwere lokale Infektionen mit Erfordernis einer Replantatentfernung. Bei mechanischem Replantatversagen kann durch operative Revision mit Spongiosaplastik das Replantat meist erhalten werden. Sofern schwere Komplikationen vermieden oder beherrscht werden, ist ein gutes funktionelles Ergebnis möglich.

Die IEIR bleibt ein Ausnahmeverfahren wenn etablierte Rekonstruktionsverfahren wie Endoprothetik, biologische Defektrekonstruktion oder Umkehrplastiken aufgrund der Tumorlokalisation oder aufgrund des Patientenwunsches nicht sinnvoll eingesetzt werden können.

Abstract

In 13 patients with primary malignant bone tumors (10 Ewing’s sarcoma, 1 parosteal osteosarcoma, 1 adamantinoma recurrence, and 1 MFH) local therapy was performed as intraoperative extracorporeal irradiation and replantation (IEIR) of the involved bone segment (5 tibia, 2 femur, and 6 pelvis). Of the 13 patients (69%), 9 are alive at the time of the follow-up (5 CDF, 4 AWMtreated) and 4 patients died of disease (DOD). Up to now during the follow-up of 32 months (6–57), no local recurrence was observed in the replanted bone segments. The complication rate was very high (18 complications in 11 of the 13 patients, including 6 cases with complication V° according to Ruggieri with loss of the reconstruction).

The typical complication is severe local infection necessitating removal of the replant. In cases of mechanical failure, the replanted segment could mostly be preserved by surgical revision and autologous bone grafting. If serious complications can be managed or avoided, functional results can be achieved.

IEIR must be seen as an extraordinary reconstruction procedure in cases where established procedures such as endoprosthesis, biological reconstructions, or rotationplasties cannot be used or are refused by the patient.

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Authors and Affiliations

  1. Abteilung Orthopädie I, Orthopädische Universitätsklinik, Heidelberg

    D. Sabo, L. Bernd, M. Buchner, V. Ewerbeck & D. Parsch

  2. Abteilung Strahlentherapie, Radiologische Universitätsklinik, Heidelberg

    M. Treiber & M. Wannenmacher

  3. Abteilung Orthopädie I, Orthopädische Universitätsklinik, Schlierbacher Landstraße 200a, 69118, Heidelberg

    D. Sabo

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  1. D. Sabo
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  2. L. Bernd
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  6. V. Ewerbeck
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Correspondence to D. Sabo.

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Sabo, D., Bernd, L., Buchner, M. et al. Intraoperative extrakorporale Irradiation und Replantation (IEIR) in der lokalen Behandlung primär maligner Knochentumoren. Orthopäde 32, 1003–1012 (2003). https://doi.org/10.1007/s00132-003-0565-4

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