Bone Fractures Following External Beam Radiotherapy and Limb-Preservation Surgery for Lower Extremity Soft Tissue Sarcoma: Relationship to Irradiated Bone Length, Volume, Tumor Location and Dose

Dickie, Colleen; Parent, Amy; Griffin, Anthony M.; Fung, Sharon; Chung, Peter; Catton, Charles; Ferguson, Peter C.; Wunder, Jay S.; Bell, Robert S.; Sharpe, Michael B.; O’Sullivan, Brian

doi:10.1016/j.ijrobp.2008.12.006

Cited by 107 publications

(46 citation statements)

References 22 publications

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“…The reported prevalence of radiation-associated fractures in heterogeneous populations after treatment for soft tissue sarcoma varies from 5% to 15% [4,13,21]. The results may be site specific.…”

Section: Discussionmentioning

confidence: 99%

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Kim

Healey

Morris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background High-dose radiation retards bone healing, compromising the surgical results of radiation-induced fractures. Prosthetic replacement has traditionally been reserved as a salvage option but may best achieve the clinical goals of eliminating pain, restoring function and avoiding complications. Questions/purposes We asked whether patients undergoing prosthetic replacement at index surgery for radiationrelated subtrochanteric or diaphyseal fractures of the femur had fewer complications than those undergoing open reduction internal fixation at index operation. Methods We retrospectively reviewed records from 1045 patients with soft tissue sarcomas treated with surgical resection and high-dose radiation therapy between 1982 and 2009 and identified 37 patients with 39 fractures. We recorded patient demographics, diagnosis, type of surgical resection, total radiation dose, fracture location and pattern, years after radiation the fracture occurred, type of surgical fixation, and associated complications. Results Patients undergoing prosthetic replacement at index surgery had a lower number of major complications and revision surgeries than those undergoing index open reduction internal fixation. Patients undergoing open reduction internal fixation at index surgery had a nonunion rate of 63% (19 of 30). Fractures located in the metaphysis were more likely to heal than those located in the subtrochanteric or diaphyseal regions. Conclusions Radiation-induced fractures have poor healing potential. Our data suggest an aggressive approach to fracture treatment with a prosthetic replacement can minimize complications and the need for revision surgery.

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Section: Discussionmentioning

confidence: 99%

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Kim

Healey

Morris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…These complications were both early, such as wound or flap necrosis, and late, such as contractures, osteitis, which can result in secondary pathologic fractures that are difficult to treat owing to poor bone healing and joint ankylosis. 23 All 3 patients for whom brachytherapy was used in the web space to avoid a double ray amputation developed complications, including metacarpophalangeal joint ankylosis, and the complications resulted in marked functional impairment. In retrospect, a primary double ray amputation might have been a better option than a single ray amputation.…”

Section: Discussionmentioning

confidence: 99%

Complications of Radiation Therapy to the Hand After Soft Tissue Sarcoma Surgery

Rohde

Puhaindran

Morris

et al. 2010

The Journal of Hand Surgery

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“…There are, however, morbidities associated with RT that severely affect a patient's heath-related quality of life. Higher RT doses and larger volumes required postoperatively have been associated with significantly greater limb fibrosis, increased joint stiffness and edema, and a higher incidence of bone fracture (5)(6)(7)(8)(9). Preoperative RT increases the risk of severe wound-healing complications that may also result in functional disability (5,6,10,11).…”

Section: Introductionmentioning

confidence: 99%

Measuring Interfractional and Intrafractional Motion With Cone Beam Computed Tomography and an Optical Localization System for Lower Extremity Soft Tissue Sarcoma Patients Treated With Preoperative Intensity-Modulated Radiation Therapy

Dickie

Parent

Chung

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Bone Fractures Following External Beam Radiotherapy and Limb-Preservation Surgery for Lower Extremity Soft Tissue Sarcoma: Relationship to Irradiated Bone Length, Volume, Tumor Location and Dose

Cited by 107 publications

References 22 publications

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Site-dependent Replacement or Internal Fixation for Postradiation Femur Fractures After Soft Tissue Sarcoma Resection

Complications of Radiation Therapy to the Hand After Soft Tissue Sarcoma Surgery

Measuring Interfractional and Intrafractional Motion With Cone Beam Computed Tomography and an Optical Localization System for Lower Extremity Soft Tissue Sarcoma Patients Treated With Preoperative Intensity-Modulated Radiation Therapy

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