Re-Implantation of Intercalary Bone Segments in Ewing`s Sarcoma Treated with Liquid Nitrogen

Yair Gortzak 1 Amir Sternheim 1,2 Solomon Dadia 1 Ortal Segal 1 Yehuda Kollander 1,2 Jacob Bickels 1,2
1The National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Here we summarize our experience with patients treated for Ewing`s Sarcoma of a long bone that have undergone intercalary resection, cryoablation and re-implantation of the involved bone.

Fifteen patients with non-metastatic Ewing sarcoma of the femoral, tibial or humeral diaphysis, age 14.1 years (range 6-31), underwent wide resection of their sarcoma after neo-adjuvant chemotherapy. The resected bone was stripped of soft tissue and the medulla was curetted out and then immersed in liquid nitrogen for 20 minutes, followed by 15 minutes in sterile water. The bone segment was filled with cement and fixation was achieved by plates, intramedullary nails or a combination of these and local bone graft. Weight bearing was initiated 3-4 months post-surgery and patients progressed to full weight bearing according to clinical inspection and repeat imaging studies showing consolidation of the osteotomy sites.

13 patients are alive and two have died at 24 and 26 months of follow up (range 6-80). Two patients had positive margins (without LR) and necrosis was above 90% in 12 patients. There have been no local recurrences and seven osteotomy sites have healed in 13 patients that are alive. Five patients needed one and two needed two and three additional procedures in order to achieve osteotomy site consolidation respectively. One deep infection/compartment syndrome occurred that ended in an above knee amputation, and one fracture healed. Eight of 13 lower limb patients ambulate without support and have satisfactory function.

Re-implantation of long bone segments in Ewing`s Sarcoma after cryoablation with liquid nitrogen is an attractive option for reconstruction, while it has a perfect fit and is readily available. Union of the osteotomy sites will be achieved as long as proper osteo-synthesis rules are followed without compromising oncological outcome.