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Radiation Dose Tied Limb Fractures in Patients With Soft Tissue Sarcomas: Presented at ASTRO
By Ed Susman
LOS ANGELES, CA -- November 5, 2007 -- Researchers reviewing hospital records said limb fractures in patients undergoing radiotherapy for treatment of soft tissue sarcoma can be reduced by avoiding irradiating the length of bone by a dose more than 60 Gray.
The doctors, who presented their findings here at the 49th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), also recommended that the mean dose of radiation to the bone itself should be less than 38 Gray and less than 60% of the bone should receive no more than 40 Gray.
Charles Catton, MD, a radiation oncologist at Princess Margaret Hospital, Toronto, Ontario, Canada, and colleagues from the University Health Network reviewed 691 cases in which patients with soft tissue sarcoma were treated with radiation between 1989 and 2004.
The research team identified 31 cases of fracture and compared them with 67 other individuals who were treated for the same cancer but did not suffer leg fractures.
"Our analysis was limited to 21 fracture and 46 non-fracture patients whose original treatment plans could be faithfully recreated using current planning software," Dr. Catton said in his poster presentation.
When compared with patients who did not suffer fractures, the doctors observed that the average maximum dose to the bone was 64 Gray in patients who suffered the leg fractures compared with 60 Gray for those who did not have fractures (P =.05). The mean dose to the bone was 45 Gray among patients with fractures compared with 39 Gray to patients who didn't suffer fractures (P =.01). The fraction of the bone involved that was irradiated to 40 Gray was 76% in the patients with fractures and 66% in patients who did not have fractures (P =.04).
"There was a trend toward lower mean field size length and boost field size length for non-fracture patients, but this did not reach statistical significance," Dr. Catton added.
Dr. Catton said that conservative therapy and pre or post-operation radiotherapy preserves limb function with high rates of local control in patients with extremely soft tissue sarcoma. He said the researchers embarked on the retrospective study -- performed without industry or outside funding -- because radiotherapy parameters have not been well documented in the medical literature.
[Presentation Title: Outcome Following Limb Salvage Surgery and External Beam Radiotherapy for High Grade Soft Tissue Sarcomas of the Groin and Axilla. Abstract 2975]
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