Abstract
This study reviews the implantation of extracorporally irradiated autografts as a treatment modality and alternative for pelvic Ewing’s Sarcoma.
We identified 13 cases between 1994 and 2004 (7 male, 6 female), with mean age 14 years (6.5–34.5). The disease free survival was 69% overall, (75% excluding one case initially treated elsewhere) with a mean follow-up of 6.1 years (3.1 – 8.2). Four patients died with distant metastases at a mean time of 17 months (13–23).
Functional results showed a median MST-Score of 86% (IQR 68.5 to 91.5), a median TES-Score 85% (IQR78.5 to 93.5) and a median Harris Hip-Score 89% (IQR 82.5 to 96.5).
Solid bony union was observed at all osteotomy sites. Consolidation was achieved after median 6 months (IQR 5 to 7).
There were three complications (23%) which required operative intervention, one (8%) due to infection, which required removal of the autograft.
Advantages with this technique include ideal fit in the defect and thus promotes healing through greater contact at osteotomy junctions. It avoids early and late loosening and/or breakage of a prosthesis. It acts as a biological bridge for creeping substitution and bony incorporation in the defect. It allows re-attachment of tendons and ligaments, and thus preserves anatomic relationships. There is no risk of disease transmission or immunological reactions. It is cost effective and convenient in any institution with radiotherapeutic equipment.
We conclude this is an appropriate treatment option for localised and resectable pelvic Ewing Sarcoma.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
