{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:10:10Z","timestamp":1791547810725,"version":"4.3.4"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,4]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Immediately recycling the resected bone segment in a biologic limb salvage reconstruction is an option after wide resection of bone. Intraoperative extracorporeal irradiation and freezing are the two major tumor-killing techniques applied on the fresh tumor-bearing autografts. However, graft-derived tumor recurrence and complications are concerns affecting graft survival.<\/jats:p>\n <\/jats:sec>\n \n Questions\/Purposes<\/jats:title>\n We therefore asked: (1) Is there a difference in the proportion of patients achieving union by 18 months after surgery between the groups with extracorporeal-irradiated autografts and frozen-treated autografts? (2) Is there any difference in the frequency of graft-related complications for patients receiving either an extracorporeal-irradiated or a frozen-treated autograft? (3) Is there a difference between the techniques in terms of graft-derived recurrence? (4) Are there differences in failure-free grafts, and limb and overall survivorship between autografts treated by extracorporeal irradiation or by freezing?<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n During the study period we treated a total of 333 patients with high-grade osteosarcoma. One hundred sixty-nine patients were excluded. Overall, 79 of the enrolled 164 patients received recycled autografts treated with extracorporeal irradiation whereas the other 85 received frozen-treated autografts. The mean followup was 82 \u00b1 54 months for the extracorporeal irradiation group and 70 \u00b1 25 months for the frozen autograft group, and one patient was lost to followup. Complications and graft failure (revision required for primary graft removal) were characterized by adapting the International Society of Limb Society (ISOLS) system modified for inclusion of biologic and expandable reconstruction. The primary study endpoints were the proportion of patients in each group who achieved radiographic union, and had an ISOLS grade of fair or good host graft fusion at 6, 9, 12, and 18 months after surgery. Five-year survival data for graft failure and limb amputation were analyzed by a cumulative incidence function regression model whereas the Kaplan-Meier function was used to test the 5-year overall survival rate between the two techniques.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n With the numbers available, no differences were found in the accumulated proportion of patients achieving union between the groups at 6, 9, 12, and 18 months. Radiographic evaluation did not show differences in the average scores of compared criteria. However in the subchondral bone subcriterion, more patients receiving frozen-treated autografts had higher scores (p = 0.03). Complications leading to a second surgery were not different between extracorporeal irradiation and frozen autografts in aspects of soft tissue failure (Type 1B), nonunion (Type 2B), structural failure (Type 3A and Type 3B), or infection (Type 4A and Type 4B). No graft-originating tumor recurrence was found and there was no difference in Type 5A tumor progression originating from soft tissue in the groups (odds ratio, 0.8; 95% CI, 0.3-2.1; p = 0.7). Neither group showed a difference in the cumulative incidence for graft failure and limb amputation. Five-year overall survival rates were 83% and 84% (p = 0.69) for extracorporeal-irradiated and frozen autografts respectively. A decrease in survivorship was seen at 50 to 100 months after surgery for the extracorporeal irradiation group.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n We segregated the ISOLS criteria evaluating the graft-mediated tumor progression into host- or graft-derived complications (Types 5B and 5C) in this study. With the available data, there was no difference in the incidence of tumor recurrence derived from irradiation- or frozen-treated autografts. Ongoing evaluations comparing 10-year survivorship for both groups will be helpful to elucidate the possible difference found after 100 months.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence Level<\/jats:title>\n III, therapeutic study<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000022","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T16:07:25Z","timestamp":1524845245000},"page":"877-889","source":"Crossref","is-referenced-by-count":69,"title":["Intraoperative Extracorporeal Irradiation and Frozen Treatment on Tumor-bearing Autografts Show Equivalent Outcomes for Biologic Reconstruction"],"prefix":"10.1097","volume":"476","author":[{"given":"Po-Kuei","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan"},{"name":"Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan"},{"name":"Orthopaedic Department School of Medicine, National Yang-Ming University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Fong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan"},{"name":"Orthopaedic Department School of Medicine, National Yang-Ming University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan"},{"name":"Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan"},{"name":"Orthopaedic Department School of Medicine, National Yang-Ming University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Taichung Veterans General Hospital, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Wen","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan"},{"name":"Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan"},{"name":"Orthopaedic Department School of Medicine, National Yang-Ming University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tain-Hsiung","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan"},{"name":"Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan"},{"name":"Orthopaedic Department School of Medicine, National Yang-Ming University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,22]]},"reference":[{"key":"R1-20230814","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/s00256-003-0657-6","article-title":"Radiographic analysis of pasteurized autologous bone graft","volume":"32","author":"Ahmed","year":"2003","journal-title":"Skeletal Radiol."},{"key":"R2-20230814","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1007\/s11999-014-3736-1","article-title":"What was the survival of megaprostheses in lower limb reconstructions after tumor resections?","volume":"473","author":"Capanna","year":"2015","journal-title":"Clin Orthop Relat Res."},{"key":"R3-20230814","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1302\/0301-620X.84B8.0841156","article-title":"Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty","volume":"84","author":"Chen","year":"2002","journal-title":"J Bone Joint Surg Br."},{"key":"R4-20230814","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00402-010-1194-0","article-title":"Pasteurized autograft-prosthesis composite for proximal femoral reconstruction: an alternative to allograft composite","volume":"131","author":"Eid","year":"2011","journal-title":"Arch Orthop Trauma Surg."},{"key":"R5-20230814","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00003086-199301000-00035","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","volume":"286","author":"Enneking","year":"1993","journal-title":"Clin Orthop Relat Res."},{"key":"R6-20230814","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1302\/0301-620X.87B7.14822","article-title":"Extracorporeal irradiated autogenous osteochondral graft: a histological study","volume":"87","author":"Hatano","year":"2005","journal-title":"J Bone Joint Surg Br."},{"key":"R7-20230814","doi-asserted-by":"crossref","first-page":"138","DOI":"10.3109\/0284186X.2014.930172","article-title":"Long-term results of intraoperative extracorporeal irradiation of autogenous bone grafts on primary bone and soft tissue malignancies","volume":"54","author":"Hayashi","year":"2015","journal-title":"Acta Oncol."},{"key":"R8-20230814","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1302\/0301-620X.96B11.34747","article-title":"Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions","volume":"96","author":"Henderson","year":"2014","journal-title":"Bone Joint J."},{"key":"R9-20230814","doi-asserted-by":"crossref","first-page":"2676","DOI":"10.1093\/annonc\/mdt252","article-title":"Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients","volume":"24","author":"Hong","year":"2013","journal-title":"Ann Oncol."},{"key":"R10-20230814","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1302\/0301-620X.96B4.32629","article-title":"The long-term outcome following the use of frozen autograft treated with liquid nitrogen in the management of bone and soft-tissue sarcomas","volume":"96","author":"Igarashi","year":"2014","journal-title":"Bone Joint J."},{"key":"R11-20230814","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/00003086-200402000-00042","article-title":"Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma","volume":"419","author":"Manabe","year":"2004","journal-title":"Clin Orthop Relat Res."},{"key":"R12-20230814","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1302\/0301-620X.94B9.29164","article-title":"Biological reconstruction after excision, irradiation and reimplantation of diaphyseal tibial tumours using an ipsilateral vascularised fibular graft","volume":"94","author":"Mottard","year":"2012","journal-title":"J Bone Joint Surg Br."},{"key":"R13-20230814","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00264-012-1715-2","article-title":"The clinical outcomes of extracorporeal irradiated and re-implanted cemented autologous bone graft of femoral diaphysis after tumour resection","volume":"37","author":"Nakamura","year":"2013","journal-title":"Int Orthop."},{"key":"R14-20230814","doi-asserted-by":"crossref","first-page":"861575","DOI":"10.1155\/2015\/861575","article-title":"Intercalary reconstruction after wide resection of malignant bone tumors of the lower extremity using a composite graft with a devitalized autograft and a vascularized fibula","volume":"2015","author":"Ogura","year":"2015","journal-title":"Sarcoma."},{"key":"R15-20230814","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/ajco.12197","article-title":"Clinical results 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