Patients: primary soft tissue sarcoma arising in the thigh and treated with limb-sparing surgery
Exclusions:
(1) bone invasion by tumor
(2) bone resection
The primary risk factor for pathologic fracture in patients was the combination of radiation therapy and periosteal stripping at surgery.
Additional risk factors for fracture in patients who underwent periosteal stripping:
(1) anatomic location of tumor (anterior compartment vs posterior, medial or indeterminate)
(2) gender of the patient (female at higher risk than males)
(3) chemotherapy
|
Risk Factor
|
Hazards Ratio from Cox Model
|
95% CI
|
p value
|
|
chemotherapy
|
6.55
|
1.35 – 31.95
|
0.020
|
|
female gender
|
11.49
|
1.42 – 92.89
|
0.022
|
from Table 4, page 2361
Patients who should have prophylactic rod placement after radiation therapy and periosteal stripping (after Figure 3, page 2364):
(1) female + chemotherapy (fracture rate 6 of 9)
(2) female + anterior compartment (fracture rate 2 of 8)
The fracture rate in males who had radiation therapy after periosteal stripping was 1 out of 28 which did not justify prophylactic rod placement.
