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Kapoor L, Singh H, Sahoo B, Banjara R, Kumar VS, Bakhshi S, Sharma DN, Khan SA. Factors affecting the incorporation of extracorporeally irradiated autograft for the treatment of bone tumours-a retrospective analysis from a tertiary referral centre. INTERNATIONAL ORTHOPAEDICS 2023; 47:1361-1372. [PMID: 36847800 DOI: 10.1007/s00264-023-05730-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Re-implantation of the tumor bearing autograft following extracorporeal radiation therapy (ECRT) has been established as an oncologically safe biological reconstruction technique following resection of bone sarcomas. However, factors affecting the ECRT graft-host bone incorporation have not been fully investigated. An insight into the factors that influence graft incorporation can circumvent the complications and increase graft survival. METHODS A total of 96 osteotomies in 48 patients with intercalary resections of primary extremity bone sarcomas (mean age 15.8 years, mean follow-up 42.1 months) were analyzed retrospectively for factors ECRT autograft-host bone union. RESULTS On univariate analysis, age < 20 years, metaphyseal osteotomy site, V-shaped diaphyseal osteotomy, and use of additional plate at diaphyseal osteotomy had a significantly faster time to union, while gender, tumour type, bone involved, resection length, chemotherapy, type of fixation, and use of intra-medullary fibula did not influence union time. In multivariate analysis, V-shaped diaphyseal osteotomy and use of additional plate at diaphyseal ostetomy were the independent factors with favourable time to union. None of the analyzed factors was found to have a significant effect on the union rate. The major complications were non-union in 11.4% patients, graft failure in 2.1%, infection in 12.5%, and soft tissue local recurrences in 14.5% patients. CONCLUSION Modified diaphyseal osteotomy and augmentation of the stability of the reconstruction using additional small plates enhance the incorporation of ECRT autograft.
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Affiliation(s)
- Love Kapoor
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hargovind Singh
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Bismaya Sahoo
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Roshan Banjara
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Madda R, Chen CM, Chen CF, Wang JY, Wu HY, Wu PK, Chen WM. Analyzing BMP2, FGFR, and TGF Beta Expressions in High-Grade Osteosarcoma Untreated and Treated Autografts Using Proteomic Analysis. Int J Mol Sci 2022; 23:ijms23137409. [PMID: 35806417 PMCID: PMC9266757 DOI: 10.3390/ijms23137409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
In the last few decades, biological reconstruction techniques have improved greatly for treating high-grade osteosarcoma patients. To conserve the limb, and its function the affected tumor-bearing bones have been treated using liquid nitrogen and irradiation processes that enable the removal of entire tumors from the bone, and these treated autografts can be reconstructed for the patients. Here, we focus on the expressions of the growth factor family proteins from the untreated and treated autografts that play a crucial role in bone union, remodeling, and regeneration. In this proteomic study, we identify several important cytoskeletal, transcriptional, and growth factor family proteins that showed substantially low levels in untreated autografts. Interestingly, these protein expressions were elevated after treating the tumor-bearing bones using liquid nitrogen and irradiation. Therefore, from our preliminary findings, we chose to determine the expressions of BMP2, TGF-Beta, and FGFR proteins by the target proteomics approach. Using a newly recruited validation set, we successfully validate the expressions of the selected proteins. Furthermore, the increased growth factor protein expression after treatment with liquid nitrogen may contribute to bone regeneration healing, assist in faster recovery, and reduce local recurrence and metastatic spread in high-grade sarcoma patients.
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Affiliation(s)
- Rashmi Madda
- Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (R.M.); (C.-M.C.); (C.-F.C.); (J.-Y.W.); (W.-M.C.)
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Chao-Ming Chen
- Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (R.M.); (C.-M.C.); (C.-F.C.); (J.-Y.W.); (W.-M.C.)
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Cheng-Fong Chen
- Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (R.M.); (C.-M.C.); (C.-F.C.); (J.-Y.W.); (W.-M.C.)
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Jir-You Wang
- Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (R.M.); (C.-M.C.); (C.-F.C.); (J.-Y.W.); (W.-M.C.)
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Hsin-Yi Wu
- Instrumentation Center, National Taipei University, Taipei 237, Taiwan;
| | - Po-Kuei Wu
- Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (R.M.); (C.-M.C.); (C.-F.C.); (J.-Y.W.); (W.-M.C.)
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-975-008-413 or +886-228-712-121 (ext. 128); Fax: +886-287-121-21 (ext. 84334)
| | - Wei-Ming Chen
- Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; (R.M.); (C.-M.C.); (C.-F.C.); (J.-Y.W.); (W.-M.C.)
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei 112, Taiwan
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