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Radiation-Induced Fractures a Significant Challenge After Sarcoma Surgery: Presented at AAOS

By Jill Stein

SAN DIEGO, CA -- February 15, 2007 -- Radiation-induced pathologic fractures continue to be a difficult problem in patients who have previously undergone treatment for soft tissue sarcoma of the extremities, investigators reported here at the at the 2007 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Kevan Saidi, MD, resident, orthopaedic surgery, London Health Science Center, Toronto, Canada, presented outcome data in 32 patients who developed 34 fractures after receiving radiation and soft tissue sarcoma resection. All subjects were treated at Mount Sinai Hospital between, 1986 and 2005.

While earlier trials identified risk factors for pathologic fractures in patients undergoing treatment for soft tissue sarcomas, the outcomes in these patients once they developed such fractures has not been studied, Dr. Saidi noted in his presentation on February 15^th.

In the present study, the researchers defined a radiation-induced pathologic fracture as a fracture that developed in the radiation field of a patient who had previously undergone combined management using radiotherapy and surgery for an extremity soft tissue sarcoma.

Of the 34 fractures, 32.3% healed and 67.7% either had a persistent non-union at the most recent follow-up, amputation for non-union, or required arthroplasty.

Fractures that did not heal occurred at a mean of 58.5 months after resection of the sarcoma. Fractures that healed occurred at an average of 19.2 months after sarcoma surgery. The difference between the two groups was not statistically significant.

Sixteen fractures (47.1%) developed after periosteal stripping at the time of sarcoma resection, while the remaining 18 fractures (52.9%) developed without periosteal stripping.

Most of the non-healed fractures were displaced fractures that were managed operatively.

The study also documented a high non-union rate of 80% in the femur. "This is worrisome and is apparently associated with a significant worsening in the patient's functional outcome," Dr. Saidi said.

"While intramedullary nailing and repeated attempts at bone grafting of femoral fractures may occasionally produce union, it may be prudent to consider alternate treatments such as vascularized fibular grafting or endoprosthetic replacement in the femur in order to avoid prolonged disability," he added.

This series is, to his knowledge, the largest case series of patients with radiation-induced fractures after surgery for soft tissue sarcoma ever reported, Dr, Saidi said.


[Presentation title: Radiation-Induced Risk and Outcome for Patients With Fractures After Surgery for Soft-Tissue Sarcoma. Abstract 312]

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