Postradiation Fractures after Combined Modality Treatment in Extremity Soft Tissue Sarcomas

Abstract

Soft tissue sarcoma (STS) of the extremities is typically treated with limb-sparing surgery and radiation therapy; with this treatment approach, high local control rates can be achieved. However, postradiation bone fractures, fractures occurring in the prior radiation field with minimal or no trauma, are a serious late complication that occurs in 2–22% of patients who receive surgery and radiation for STS. Multiple risk factors for sustaining a postradiation fracture exist, including high radiation dose, female sex, periosteal stripping, older age, femur location, and chemotherapy administration. The treatment of these pathological fractures can be difficult, with complications including delayed union, nonunion, and infection posing particular challenges. Here, we review the mechanisms, risk factors, and treatment challenges associated with postradiation fractures in STS patients.

Risk factors associated with 30‐day complications following lower extremity sarcoma surgery: A national surgical quality improvement project analysis

“…Lower extremity (LE) sarcomas, in particular, are associated with an increased risk of surgical complications compared to tumors located within the upper extremity 12,13 . In addition, prior studies have found that the use of radiation therapy in the perioperative period can further increase the incidence of complications seen in this patient population 14–16 . Unfortunately, the lower limb is also the most common location in which soft tissue sarcomas arise 12 .…”

“…12,13 In addition, prior studies have found that the use of radiation therapy in the perioperative period can further increase the incidence of complications seen in this patient population. [14][15][16] Unfortunately, the lower limb is also the most common location in which soft tissue sarcomas arise. 12 The purpose of our study is to comprehensively investigate risk factors predisposing to postoperative complications following limb-sparing, LE sarcoma surgery.…”

Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas

“…There were multiple early complications secondary to wound healing complications. While radiation therapy improves rates of local control, it is not a benign intervention and is associated with the complications observed in our study [ 4 , 32 , 33 , 34 , 35 ]. Although consideration for postoperative radiotherapy can be given, the permanent functional complications of stiffness and fibrosis, especially around joints, occur secondary to the higher treatment doses and volumes [ 36 , 37 ].…”

Incidence and Risk Factors for Extremity Osteoradionecrosis after Limb-Sparing Surgery and Adjuvant Radiotherapy

“…For example, postradiation fractures have been reported with an incidence of 1.2–6.4% and with well-established risk factors [ 33 ]. These fractures can occur without significant trauma due to changes in the mechanical strength of the bone after irradiation [ 34 ]. In our study, eight patients (4.0%) experienced pathological fractures, and five of them were managed as ORN based on the clinical history, imaging, and assessment of soft tissue quality.…”