LIMB SALVAGE IN PRIMARY MALIGNANT BONE TUMORS BY INTRAOPERATIVE MICROWAVE HEAT TREATMENT

摘要

Objective. To use intraoperative microwave heat for the treatment of tumor-bearing bone in situ for limb-salvage in primary malignant bone tumor. Patients and Methods. Twenty-five patients with malignant bone tumor received surgical protocol for limb-salvage by wide exposure and intraoperative microwave heat treatment of tumor bone in situ. The tumor was localized at distal femur in 16 patients, proximal tibia in 5, shaft of femur in 2, and illia in 2. Results. The pathological diagnosis revealed osteosar-coma in 16 patients, parosteal osteosarcoma in 4. chondrosarcoma in 3, and leiomyosarcoma in 2. The stage of tumor was classified into IIB in 16 patients, IIA in 6, and IIIB in 3. The operative technique was wide exposure for tumor in soft tissues, protecting the surrounding normal tissue from heat injury by copper mesh, and heating tumor-bearing bone at 50 ℃ for 15 minutes. The patients were followed up from 4 to 180 months (mean, 63 months). The survival rate of 2, 5 and 10 years was 81.3%, 70.4%, and 53.8% respectively. The functional results were less than 50% in 4 patients, between 50% and 75% in 9, and more than 75% in 12, referred to the normal function of a normal limb. The complications consisted of infection in 4 patients, pathological fracture in 4, and separation of epiphysis in 1. Oncological results showed that local recurrences of tumor were in 4 patients, and 6 patients suffered from distant metastasis. Conclusion. The treatment is an alternative to replacement by prosthesis or allograft bridging techniques.