Pathological fracture after radiotherapy: systematic review of literature

Abstract

SUMMARY OBJECTIVE: To evaluate the epidemiological data and available treatments for fractures secondary to radiotherapy treatment. METHODS: Identification of publications on pathological skeletal fractures previously exposed to ionizing radiation. RESULTS: The incidence of fractures after irradiation varies from 1.2% to 25% with a consolidation rate of 33% to 75%, being more frequent in the ribs, pelvis, and femur. The time elapsed between irradiation and fracture occurs years after radiotherapy. Risk factors include age above 50 years, female gender, extensive periosteal detachment, circumferential irradiation, tumor size, and anterior thigh location. The etiology is still uncertain, but cellular disappearance, reduction of bone turnover and activity were observed hematopoietic as possible causes of failure of consolidation. CONCLUSION: There is no consensus in the literature on the factors related to the development of fractures, with radiation dose, previous tumor size and periosteal detachment being suggested as potential factors.

Medial clavicle fracture with bone destruction after radical neck dissection combined with postoperative chemotherapy for secondary cervical lymph node metastasis of tongue cancer: a case report

“…The pathogenesis of bone destruction in CF after neck dissection might be associated with multiple factors, and the cause for the bone destruction in the current patient has not yet been identified. However, comparing the present and previous cases of CF, our case suggests that postoperative chemotherapy after RND might contribute to bone destruction in CF, even in the absence of radiotherapy [8,16] and infection [14] of the clavicle. The influence of chemotherapy on the occurrence of CF after neck dissection remains unknown.…”

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

“…In comparison, our solution is characterized by a more homogeneous dose distribution as well as a much better dose conformity, which results in a significant lower dose to bones (femur and tibia). Regarding bone sparing, our achievement should decrease the risk for radiation-related pathological fracture [21]. In such an effort, we reached a femur mean dose that is about half of the target prescription dose.…”

Fratura em fêmur irradiado de rato: Descrição de um modelo experimental e avaliação de sua eficácia

“…Os tecidos saudáveis expostos ao campo de ação sofrem alterações fisiológicas que podem provocar complicações de difícil resolução. 1 Especificamente no tecido esquelético, a radioterapia pode causar necrose, osteíte actínica, osteomielite e fraturas patológicas que podem evoluir para a ausência de consolidação. Embora estas complicações sejam descritas com frequência, pouco se sabe sobre sua etiologia e resolução.…”