Types of surgery for cancer treatment using 3D-printed implants

Introduction. Routine endoprosthesis production does not have ready solutions for such rare locations as forearm bones, scapula, and breastbone. In the last decade, 3D printing of personalized implants has been actively developing. Its benefits are accurate anatomical compliance with the resected segment, quick manufacturing time, and low cost. Oncoortopedics finds use of more additional technologies.
Aim. To show through clinical observations the advantages of qualitatively new biologically and mechanically compatible implants used to replace bone defects in anatomically complex locations and to promote the use of such endoprosthesis in clinical practice.
Materials and methods. Organ-saving treatment using personalized implants manufactured using 3D printing technology was performed in 7 patients with bone tumors: 3 with primary bone tumors (sarcomas) and 4 with metastases. Tumor lesions were localized in the humerus in 2 cases, in the scapula in 2 cases, in the breastbone in 2 cases, and in the distal part of the radius in 1 case. The implants were designed based in the spiral computed tomography data. For implant manufacturing, direct metal laser sintering (DMLS) was used. Titanium alloy Ti6Al4V certified for production of medical implants was used as the material. Design and manufacturing took 3 weeks.
Results. Morphological examination showed negative tumor resection margin in all patients. All 7 patients are alive. No intraoperative complications were reported. Follow up varied between 1 and 8 months. During follow up, disease progression was not observed. Mean functional score per the Musculoskeletal Tumour Society score (MSTS) was 80 % (between 72 and 94 %).
Conclusion. Development of qualitatively new Russian oncological implants using 3D-printing technology is one of the most important areas in bone pathology.

1. Алиев М.Д., Сушенцов Е.А. Современная онкоортопедия. Саркомы костей, мягких тканей и опухоли кожи 2012;4:3–10. Aliyev M.D., Sushentsov E.A. Modern oncoortopedia. Sarkomy kostej, myagkikh tkanej i opukholi kozhi = Bone and soft tissue sarcomas, tumors of the skin 2012;4:3–10. (In Russ.).

2. Карпенко В.Ю., Бухаров А.В., Курильчик А.А. и др. Эндопротезирование при опухолевом поражении дистальных отделов конечностей. Онкология. Журнал им. П.А. Герцена 2017;5:31–6. Karpenko V.Yu., Bukharov A.V., Kurilchik A.A. et al. Endoprosthetics in case of tumor lesion of the distal extremities. Onkologiya. Zhurnal im. P.A. Gercena = Oncology. P.A. Herzen Journal 2017;5:31–6. (In Russ.).

3. Жеравин А.А., Таранов П.А., Красильников С.Э. и др. Внедрение инновационных аддитивных технологий в медицинскую практику ФГБУ «НМИЦ им. акад. Е.Н. Мешалкина» Минздрава России. Саркомы костей, мягких тканей и опухоли кожи 2021;1:11–15. DOI: 10.17650/2070-9781-2021-13-1-11-15 Zheravin A.A., Taranov P.A., Krasilnikov S.E. et al. Introduction of innovative additive technologies into the medical practice of FSBI “NMIC im. Academician E.N. Meshalkina” Ministry of Health of Russia. Sarkomy kostej, myagkikh tkanej i opukholi kozhi = Bone and soft tissue sarcomas, tumors of the skin 2021;1:11–15. (In Russ.). DOI: 10.17650/2070-9781-2021-13-1-11-15

4. Агаев Д.К., Сушенцов Е.А., Софронов Д.И. и др. Применение компьютерного моделирования и 3D-технологий в онкоортопедии. Обзор литературы. Саркомы костей, мягких тканей и опухоли кожи 2019;4:5–16. Agaev D.K., Sushentsov E.A., Sofronov D.I. et al. Application of computer modeling and 3D technologies in oncoortopedia. Literature review. Sarkomy kostej, myagkikh tkanej i opukholi kozhi = Bone and soft tissue sarcomas, tumors of the skin 2019;4:5–16. (In Russ.).

5. Xiao J.-R., Wen-Ding Huang W.-D.., Yang X.-H. et al. En bloc resection of primary malignant bone tumor in the cervical spine based on 3-dimensional printing technology. Orthop Surg 2016;8(2):171–8. DOI: 10.1111/os.12234

6. Жеравин А.А., Гюнтер В.Э., Анисеня И.И. и др. Реконструкция грудной стенки с использованием никелида титана у онкологических больных. Сибирский онкологический журнал 2015;3:31–8. Zheravin A.A., Gunter V.E., Anisenya I.I. et al. Reconstruction of the chest wall using titanium nickelide in cancer patients. Sibirskij onkologicheskij zhurnal = Siberian Journal of Oncology 2015;3:31–8.(In Russ.).

7. Akiba T., Marushima H., Nogi H. et al. Chest wall reconstruktion using Gore-Tex® dual mesh. Ann Thorac Cardiovasc Surg 2012;18(2):166–9. DOI: 10.5761/atcs.cr.11.01718

8. Давыдов М.И., Алиев М.Д., Тепляков В.В. и др. Лечение местнораспространенных опухолей грудной стенки. Два случая из практики. Вестник РОНЦ им. Н.Н. Блохина РАМН 2003;2–1:93–6. Davydov M.I., Aliyev M.D., Teplyakov V.V. et al. Treatment of locally common tumors of the chest wall. Two cases from practice. Vestnik RONC im. N.N. Blohina RAMN = Bulletin of the N.N. Blokhin Russian Research Center of the Russian Academy of Medical Sciences 2003;2–1:93–6. (In Russ.).

9. Тепляков В.В., Карпенко В.Ю., Илюшин А.Л. и др. Хирургическое лечение злокачественных опухолей грудной стенки. Хирургия. Журнал им. Н.И. Пирогова 2010;9:36–41. Teplyakov V.V., Karpenko V.Yu., Ilyushin A.L. et al. Surgical treatment of malignant tumors of the chest wall. Hirurgiya. Zhurnal im. N.I. Pirogova = Surgery. N.I. Pirogov Journal 2010;9:36–41.

10. Давыдов М.И., Алиев М.Д., Соболевский В.А. и др. Хирургическое лечение злокачественных опухолей грудной стенки. Вестник РОНЦ им. Н.Н. Блохина РАМН 2008;19(1):35–40. Davydov M.I., Aliyev M.D., Sobolevsky V.A. et al. Surgical treatment of malignant tumors of the chest wall. Vestnik RONC im. N.N. Blohina RAMN = Bulletin of the N.N. Blokhin Russian Research Center of the Russian Academy of Medical Sciences 2008;19(1):35–40. (In Russ.).