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.
Highlights
Postradiation fractures, those that occur in a prior radiation field and are associated with minimal or no trauma, pose a significant challenge for both patients and orthopedic surgeons. ese fractures occur in 2–22% of Soft tissue sarcoma (STS) patients treated with a combination of surgery and radiation therapy (RT), with higher rates in at-risk populations [8,9,10,11,12]
RT is associated with several serious skeletal complications, including radiation osteitis [3], avascular necrosis [4], stress fractures [5], delayed wound healing [6], growth plate arrest in skeletally immature patients [7], and fractures. Postradiation fractures, those that occur in a prior radiation field and are associated with minimal or no trauma, pose a significant challenge for both patients and orthopedic surgeons. ese fractures occur in 2–22% of STS patients treated with a combination of surgery and RT, with higher rates in at-risk populations [8,9,10,11,12]
Our objective is to review the mechanisms, risk factors, treatment modalities, and challenges associated with postradiation fractures in STS patients
Summary
Postradiation fractures, those that occur in a prior radiation field and are associated with minimal or no trauma, pose a significant challenge for both patients and orthopedic surgeons. ese fractures occur in 2–22% of STS patients treated with a combination of surgery and RT, with higher rates in at-risk populations [8,9,10,11,12]. Ese fractures occur in 2–22% of STS patients treated with a combination of surgery and RT, with higher rates in at-risk populations [8,9,10,11,12]. Related to cellular changes are architectural changes to bone that occur after exposure to ionizing radiation. Green et al.’s study found reduced total new vessel formation at fracture sites, suggesting vascular damage as another potential contributor to RT-induced pathologic changes in bone [23]. Four weeks after a single dose of radiation, dilation of microvasculature and occlusion of Haversian vessels with cell loss were noted, along with abnormal osteoclastic resorption of perivascular bone matrix [13]. At 12 weeks after radiation exposure, decreased vascularity became prominent
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