Postradiation Fractures after Combined Modality Treatment in Extremity Soft Tissue Sarcomas

Table 1

Studies of risk factors for postradiation fractures in patients with STS treated with surgery and RT.

Author	Year	No. of patients	No. of fractures	STS location	Significant variables identified	Reference
Brant et al.	1990	52	4	Long bone	Periosteal stripping, age, female gender; descriptive only	[29]
Lin et al.	1998	205	5	Thigh	Univariate: compartment, periosteal stripping, female gender, chemotherapy, age, RT type; Multivariate: periosteal stripping; Secondary multivariate model: female gender, chemotherapy	[11]
Helmstedter et al.	2001	285 (thigh subset: 163)	20 (thigh subset: 12)	Extremity	Logistic regression (thigh subset): periosteal stripping, compartment, marginal/intralesional resection	[30]
Holt et al.	2006	354 (thigh subset: 239)	27 (thigh subset: 24)	Lower extremity	Univariate: periosteal stripping, compartment, age, radiation dose; Multivariate: age, radiation dose; Univariate (thigh subset): female gender, age; Multivariate (thigh subset): female gender, age, radiation dose, radiation timing	[9]
Livi et al.	2005	214	7	Extremity	None	[31]
Dickie et al.	2009	691	31^a	Lower extremity	Radiation dose (mean, maximum, proportional volume irradiated)	[32]
Gortzak et al.	2010	101	22	Thigh	Univariate: age, tumor size, periosteal stripping, compartment; Multivariate: age, tumor size, gender	[12]
Kim et al.	2010	1045	39	Thigh	Diaphyseal location; descriptive only	[33]
Pak et al.	2012	131	5	Proximal lower extremity	Radiation dose^b	[34]
Bishop et al.	2016	596	12	Proximal lower extremity	Univariate competing risk; bone exposure, periosteal stripping, chemotherapy, age; Time to fracture analysis: bone exposure, periosteal stripping, chemotherapy	[8]
Folkert et al.	2019	92	6	Thigh and groin	Univariate: age (<60), compartment, periosteal stripping; Multivariate: age (<60), periosteal stripping; IMRT rate < expected rate for EBRT	[35]

^a24 fractures (in 21 patients) could be analyzed, ^bDosimetric analysis limited to 4 fractures. STS: soft tissue sarcoma; RT: radiation therapy; No.: number; IMRT: intensity-modulated radiation therapy; EBRT: external beam radiation therapy.