ESTRO 36 Abstract Book

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S387 ESTRO 36 2017
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particular care, with the aid of surgical reports and
diagnostic imaging.
PO-0743 Retransplantation of bony autografts
sterilized by extracorporal high dose irradiation
L. Saleh-Ebrahimi1 , A. Klein2, Y. Bakhshai2, F. Roeder1,3,
A. Baur-Melnyk4, T. Knösel5, L.H. Lindner 6, V. Jansson2,
H.R. Dürr2
1 LMU Munich, Department of Radiation Oncology,
Munich, Germany
2 LMU Munich, Department of Orthopedics, Munich,
Germany
3 German Cancer Research Center DKFZ, Department of
Molecular Radiation Oncology, Heidelberg, Germany
4 LMU Munich, Department of Radiology, Munich,
Germany
5 LMU Munich, Department of Pathology, Munich,
Germany
6 LMU Munich, Department of Internal Medicine, Munich,
Germany
Purpose or Objective
Limb-sparing resection of bone tumors requires
reconstruction of the bony defect. Retransplantation of
the resected bone after sterilisation might be an
alternative to prothetic implants especially in cases with
diaphyseal defects. Here we report our experience with
this technique using extracorporal high dose irradiation to
sterilize the resected bone.
Material and Methods
Extracorporal irradiation and retransplantation was used
in 20 patients (21 lesions) between 2005 and 2015. 13
patients were male and median age was 37 years (10-83)
with 4 patients <18 years. Main histologies were Ewing
sarcoma (7 pts), Osteosarcoma (5) and metastasis (5).
Lesions were located mainly in the lower limb (femur
n=12, tibia n=6). After resection and curettage, the
tumor-bearing bone was packed into a double sterile bag
and transported to the radiation oncology department. To
minimize any built-up effect, the bag was wrapped with
flap material and placed beneath the LINAC with the
lowest possible distance to the head, usually on a tray in
the accessory slot. After irradiation with 300 Gy in ap/pa
technique, the bone was brought back to the operation
room and retransplanted.
Results
Median follow up was 33 months (6-129) in the entire
cohort and 39 months in survivors. Retransplantation was
possible in all patients. An additional fibula augmentation
was used in 14 lesions. Surgical revisions (median n=2,
range 1-8) were needed in 12 lesions (57%) due to
complications or pseudoarthrosis. Complete integration of
the irradiated autograft was finally achieved in 17 of 19
possible lesions (89%). One patient failed with active
pseudoarthrosis and in one patient a prothetic implant was
needed secondarily due to a fractured pseudoarthrosis. In
two patients with retransplantation of the whole
irradiated calcaneus, integration was formally not
possible. Median time to complete integration was 10
months (4-35 months). Local control inside the graft and
in the affected limb was achieved in 100% and 95% of the
patients, respectively. One patient developed recurrence
outside the replanted graft, probably due to seeding
because of fracture hematoma. Four patients have died,
resulting in a 5-year overall survival of 68 %.
Conclusion
High dose extracorporal irradiation is an effective and safe
method to sterilize bony autografts during a
retransplantation procedure. Local control is achieved in
95%-100%. Complications with the need for surgical
revisions occur frequently resulting in a prolonged healing
process in more than half of the patients. However,
successful integration of the sterilized autografts is finally
achieved in the vast majority (roughly 90%).
Retransplantation after extracorporal irradiation seems to
be a very promising alternative to prothetic implants
especially in the treatment of diaphyseal or
metadiasphyseal lesions.
PO-0744 Brachytherapy and external beam radiation
therapy after re-excision surgery in soft tissue sarcomas
A. Cortesi1,2, A. Arcelli1,3, L. Giaccherini1, A. Galuppi1, V.
Panni1, A. Zamagni 1, S. Bisello1, F. Romani4, G. Bianchi5,
S. Campagnoni 5, M. Gambarotti6, G. Ghigi 2, S.
Micheletti 7, G. Macchia8, F. Deodato8, S. Cilla9, G.P.
Frezza3, A.G. Morganti 1, S. Cammelli 1
1University of Bologna, Radiation Oncology Center-
Department of Experimental- Diagnostic and Specialty
Medicine - DIMES, Bologna, Italy
2Istituto Scientifico Romagnolo per lo Studio e la Cura
dei Tumori IRST- IRCCS, Radiotherapy Department,
Ravenna, Italy
3Ospedale Bellaria, Radiotherapy Department, Bologna,
Italy
4S. Orsola-Malpighi Hospital- University of Bologna,
Medical Physic Unit, Bologna, Italy
5Rizzoli Institute, Department of Orthopaedic Oncology,
Bologna, Italy
6Istituto Ortopedico Rizzoli, Department of Pathology,
Bologna, Italy
7Istituto Scientifico Romagnolo per lo Studio e la Cura
dei Tumori IRST- IRCCS, Radiotherapy Department,
Meldola, Italy
8Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Radiotherapy Unit, Campobasso, Italy
9Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Medical Physics Unit, Campobasso, Italy
Purpose or Objective
To evaluate outcomes in patients with primary high grade
soft tissue sarcomas (STS), treated with perioperative
brachytherapy (BRT) and adjuvant external beam
radiation therapy (EBRT) after re-excision of the tumor
bed, post unplanned surgery.
Material and Methods
The primary aim of this retrospective study was to analyse
local control (LC). Secondary objective were metastasis-
free survival (MFS), diseases-free survival (DFS) and
overall survival (OS) in a large patient population. BRT
delivered dose was 20 Gy (15-22 Gy) using Low Dose-Rate
or Pulsed Dose-Rate technique. EBRT was delivered with
3D-technique using multiple beams; the median
prescribed dose was 46 Gy to the PTV (range 40-60 Gy),
conventionally fractionated. Univariate analysis was
estimated according to Kaplan-Meier method and log-rank
test.
Results
From 2000 to 2011, 121 patients (median age: 50 years,
range 16-86; median follow-up: 54 months), affected by
primary high grade STS, underwent unplanned surgery, re-
excision of the tumor bed (radicalization) within a
maximum of 3-6 months from the previous surgery,
perioperative BRT and adjuvant EBRT. Seventeen patients
(14.0%) developed metastases, 7 patients (5.8%) relapsed
and 9 out of 121 patients died (7.4%). Five-year LC and OS
were 93.0% and 91.6%, respectively. At univariate analysis
higher 5-year DFS and OS were recorded in patients with
lower- limb tumors vs upper-limb and trunk STS (p: 0.053
and 0.041, respectively). Although it wasn’t detected any
statistical significance related to histologies. Younger
patients (< median age) showed improved 5-year LC (97.9%
vs 88.1%, p: 0.052), 5-year DFS (88.9% vs 73.9%, p: 0.034)
and 5-year OS (96.5% vs 86.6%, p: 0.093).
Conclusion
The combination of BRT and EBRT is able to achieve
satisfactory results, with a high local control rate and
overall survival. Prospective studies on combined modality
treatment in the adjuvant setting of STS after re-excision
surgery or inadequate excision are still needed to improve
the results in STS of the trunk and limb.