PMC5798423_01
Computed tomography scan presenting the supraacetabular location of bone metastasis prior to surgery
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CT revealed a closed osteolytic lesion in the right iliac bone, ~15 cm3 in volume without cortex penetration (Fig. 1).
Intraoperative pictures demonstrating (A) surgical exposure of the pelvic bone, (B) doxorubicin administration to the pelvic lesion and (C) closure of the osteotomy site following doxorubicin application
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The patient underwent surgery in the supine position; the highest and most anterior possible site of bone penetration in the supraacetabular region was chosen, allowing the drug to be administered precisely without contact with surrounding tissues or the possibility of leakage from the administration site (Fig. 2A). Pathomorphology analysis confirmed the presence of tumor cells and 5 mg doxorubicin liquid (2.5 ml; suspended in a solution of sodium chloride and hydrochloric acid) was applied to the defect (Fig. 2B). The cavity was closed with the piece of bone cortex obtained during osteotomy (Fig. 2C).
Anteroposterior intraoperative X-ray showing the location of the metastasis. The contrast material was confined to the cavity, indicating that it was sealed
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The tightness of the cavity was checked intraoperatively using contrast liquid (Fig. 3).
Computed tomography scans showing (A) the pelvic bone following metastasis removal and filling of the cavity with doxorubicin,(B) the bone cavity 4 months after reconstruction using bone allografts and (C) the completely healed bone allografts 14 months after implantation
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Postoperative CT was performed during the hospitalization period (Fig. 4A). The metastatic region was radiologically evaluated by CT at 4 and 14 months after the second operation, revealing complete healing of the bone allografts (Fig. 4B and C).