Pathologic femur fractures after limb-sparing treatment of soft-tissue sarcomas.
BACKGROUND
Local control for sarcomas of the long bones includes limb sparing surgery and radiotherapy. While effective, there are potential complications.


METHODS
Patients treated for a soft tissue sarcoma of the thigh with limb-sparing surgery and radiation therapy between 1986 and 2000 at the University of Minnesota Masonic Cancer Center (n=89) were identified. Demographic, tumor, and treatment characteristics were abstracted from the medical record. Univariate analysis was conducted to identify significant risk factors for fracture.


RESULTS
Survivors (58% male), median age of 50 (7-88) years, reported 8 (9%) fractures at a median of 7.3 (0.8-21.9) years from diagnosis after a median of 6300 (2000-7020) cGy of radiation. All fractures occurred within the previous radiation field, after no trauma. Three of the 8 (37.5%) had delayed union, 2 (25%) nonunion healing. Significant risk factors included periosteal stripping (p=0.006), anterior compartment location (p=0.022), and having 100% of the femoral circumference irradiated (p=0.018). Taking into account time to fracture using Kaplan Meier and log rank tests, these same predictors were identified. Older age, female sex, use of chemotherapy, and timing of radiation were not predictive of femoral fracture.


CONCLUSIONS
Anterior tumor location, periosteal stripping, and radiation to 100% of the femur circumference are associated with femoral fracture. These patients require long-term monitoring and may warrant prophylactic intramedullary pinning or other protective measures.


CONCLUSIONS
Survivors of soft tissue sarcomas of the femur may be at risk for the development of femur fractures and warrant close observation.
Blaes
Anne H
AH
Department of Medicine, Division of Hematology/Oncology/Transplantation, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN 55455, USA. blaes004@umn.edu
Lindgren
Bruce
B
Mulrooney
Daniel A
DA
Willson
Lauren
L
Cho
L Chinsoo
LC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy*; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000534:rehabilitation; D020266:Radiotherapy, Conformal / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D013848:Thigh / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D055815:Young Adult
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