Femoral Fracture in Primary Soft-Tissue Sarcoma of the Thigh and Groin Treated with Intensity-Modulated Radiation Therapy: Observed versus Expected Risk
| Autor: | Aimee M. Crago, Michael R. Folkert, Kaled M. Alektiar, Dana L. Casey, Sean L. Berry, Nicola Fabbri, Samuel Singer |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Groin Article Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Prospective Studies Radiation Injuries Survival rate Anterior compartment of thigh Aged Aged 80 and over Univariate analysis Femur fracture business.industry Soft tissue sarcoma Sarcoma Femoral fracture Middle Aged Nomogram Prognosis medicine.disease Survival Rate Nomograms medicine.anatomical_structure Thigh Oncology 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Surgery Radiotherapy Intensity-Modulated Nuclear medicine business Femoral Fractures Follow-Up Studies |
| Zdroj: | Ann Surg Oncol |
| ISSN: | 1534-4681 1068-9265 |
| Popis: | This study was designed to compare the observed risk of femoral fracture in primary soft-tissue sarcoma (STS) of the thigh/groin treated with intensity-modulated radiation therapy (IMRT) to expected risk calculated using the Princess Margaret Hospital (PMH) nomogram.Expected femoral fracture risk was calculated by using the PMH nomogram. Cumulative risk of fracture was estimated by using Kaplan-Meier statistics. Prognostic factors were assessed with univariate and multivariate analysis using Cox's stepwise regression.Between February 2002 and December 2010, 92 consecutive eligible patients were assessed. Median follow-up was 73 months (106 months in surviving patients). IMRT was delivered preoperatively (50 Gy) in 13 (14%) patients and postoperatively in 79 (86%) patients (median dose, 63 Gy; range, 59.4-66.6 Gy). The observed crude risk of fractures was 6.5% compared with 25.6% expected risk from the nomogram; the cumulative risk of fracture using IMRT at 5 years was 6.7% (95% CI 2.8-16.0%). The median time to fracture was 23 months (range, 6.9-88.6). Significant predictors of fracture on univariate analysis were age ≥ 60 years (p = 0.03), tumor location in the anterior thigh (p = 0.008), and periosteal stripping to 20 cm (p 0.0001). On multivariate analysis, age ≥ 60 years and periosteal stripping 20 cm retained significance (p = 0.04 and p = 0.009, respectively).In this study, the cumulative risk of femur fracture in patients treated with IMRT (6.7%) is less than the expected risk using the PMH nomogram (25.6%). Established predictors of femur fracture, such as gender, tumor size, and dose of RT, seem to have less impact on fracture risk when using IMRT. |
| Databáze: | OpenAIRE |
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