Pathologic femoral fracture after periosteal excision and radiation for the treatment of soft tissue sarcoma Journal Article
| Authors: | Lin, P. P.; Schupak, K. D.; Boland, P. J.; Brennan, M. F.; Healey, J. H. |
| Article Title: | Pathologic femoral fracture after periosteal excision and radiation for the treatment of soft tissue sarcoma |
| Abstract: | BACKGROUND. Surgical resection and adjuvant radiation therapy are standard therapy for soft tissue sarcomas. When the tumor approximates bone, periosteal excision may be necessary. It was hypothesized that periosteal stripping and radiation therapy would increase the rate of pathologic fracture. METHODS. The soft tissue sarcoma data base at the Memorial Sloan- Kettering Cancer Center was used to identify a consecutive series of 205 patients who were treated over a 15-year period (1982-1997). All patients had a soft tissue sarcoma of the thigh, which was managed by limb-sparing surgery and radiation therapy. Patients who had bone invasion by tumor or bone resection were not included. RESULTS. Nine patients, including eight women and one man, developed a femoral fracture in an area of previous radiation and surgery. All nine patients had undergone periosteal excision. The risk of fracture, by Kaplan-Meier survivorship, was 29% at 5 years if the resection included periosteum (P < 0.0001). Cox multiple regression analysis showed that periosteal excision was the only independent prognostic factor for the entire set of 205 patients at risk. However, for the subset of 54 patients who had periosteal stripping, two factors were also found to be prognostically important: female gender (P = 0.022) and chemotherapy (P = 0.020). The risk of fracture was 47% and 45%, respectively. The treatment of the fractures was difficult. There were four nonunions and three delayed unions. CONCLUSIONS. Periosteal stripping and radiation therapy places the femur at high risk of pathologic fractures, especially for female patients and patients undergoing chemotherapy. When practical, the combination of periosteal stripping and radiation should be avoided. |
| Keywords: | adult; cancer chemotherapy; aged; aged, 80 and over; middle aged; cancer surgery; retrospective studies; major clinical study; doxorubicin; cancer radiotherapy; radiotherapy, adjuvant; risk factors; periosteum; risk assessment; sarcoma; postoperative complication; radiation effects; radiation oncology; soft tissue sarcoma; sex difference; sex factors; femur fracture; radiation necrosis; soft tissue neoplasms; sex; fractures; fracture healing; fracture nonunion; osteitis; femoral fractures; fractures, spontaneous; pathologic fracture; humans; human; male; female; priority journal; article |
| Journal Title: | Cancer |
| Volume: | 82 |
| Issue: | 12 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 1998-06-15 |
| Start Page: | 2356 |
| End Page: | 2365 |
| Language: | English |
| DOI: | 10.1002/(sici)1097-0142(19980615)82:12<2356::aid-cncr9>3.0.co;2-q |
| PUBMED: | 9635528 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Presented at the 65th Annual Meeting of the American Academy of Orthopaedic Surgeons that took place March 19 –23, 1998 in New Orleans, LA and presented as a poster at the 9th International Symposium of Limb Salvage that took place September 10–12, 1997 in New York, NY -- Export Date: 12 December 2016 -- Source: Scopus |
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