The risks and benefits of radiotherapy with massive endoprosthetic replacement.
Between 1966 and 2001, 1254 patients underwent excision of a bone tumour with endoprosthetic replacement. All patients who had radiotherapy were identified. Their clinical details were retrieved from their records. A total of 63 patients (5%) had received adjunctive radiotherapy, 29 pre-operatively and 34 post-operatively. The mean post-operative Musculoskeletal Tumor Society scores of irradiated patients were significantly lower (log-rank test, p = 0.009). The infection rate in the group who had not been irradiated was 9.8% (117 of 1191), compared with 20.7% (6 of 29) in those who had pre-operative radiotherapy and 35.3% (12 of 34) in those who radiotherapy post-operatively. The infection-free survival rate at ten years was 85.5% for patients without radiotherapy, 74.1% for those who had pre-operative radiotherapy and 44.8% for those who had post-operative radiotherapy (log-rank test, p < 0.001). The ten-year limb salvage rate was 89% for those who did not have radiotherapy and 76% for those who did (log-rank test, p = 0.02). Radiotherapy increased the risk of revision (log-rank test, p = 0.015). A total of ten amputations were necessary to control infection, of which nine were successful. Radiotherapy may be necessary for the treatment of a bone sarcoma but increases the risk of deep infection for which amputation may be the only solution.
Jeys
L M
LM
Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham B31 2AP, UK. lee.jeys@btclick.com
Luscombe
J S
JS
Grimer
R J
RJ
Abudu
A
A
Tillman
R M
RM
Carter
S R
SR
D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009372:Neoplasms, Connective Tissue / Q000532:radiotherapy* / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000209:etiology*; D011832:Radiation Injuries / Q000150:complications*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012307:Risk Factors; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome