Gortzak et al developed a nomogram for predicting the risk of pathologic fracture of the femur following combined modality therapy for a soft tissue sarcoma of the thigh. The authors are from the University of Toronto, Sourasky Medical Center in Tel Aviv, and teaching hospitals in Toronto, Canada.
Paramters:
(1) gender
(2) age in years
(3) compartment
(4) tumor diameter in cm
(5) radiation dose
(6) periosteal stripping in cm
Age in Years |
Points |
---|---|
< 20 years |
0 |
20 to 90 years |
(1.4286 * (age)) - 28.572 |
> 90 years |
100 |
Tumor Size |
Points |
---|---|
0 to 28 cm |
2.939 * (diameter in cm) |
> 28 cm |
82 |
Parameter |
Finding |
Points |
---|---|---|
gender |
male |
0 |
|
female |
34.6 |
compartment |
posterior |
0 |
|
anterior |
48.3 |
|
adductor |
25.5 |
|
other (abductor, groin) |
4 |
radiation dose |
low (50 Gy) |
0 |
|
high (>= 60 Gy) |
12.6 |
periosteal stripping |
< 10 cm |
0 |
|
10 to 20 cm |
14.6 |
|
> 20 cm |
9.4 |
total score =
= SUM(points for all 6 paramters)
Interpretation:
• minimum score: 0
• maximum score: 290+
• The higher the score the greater the risk of pathologic fracture.
Total Score |
Probability of Pathologic Fracture |
---|---|
< 128 |
< 5% |
128 to 161 |
(0.008863 * ((points)^2)) - (1.898 * (points)) + 102.4 |
161 to 199 |
(1.316 * (points)) - 186.8 |
199 to 232 |
(-0.008863 * ((points)^2)) + (4.484 * (points)) - 467.9 |
> 232 |
> 95% |
Purpose: To predict the risk of a pathologic fracture of the femur following combined modality therapy of a soft tissue sarcoma of the thigh.
Specialty: Hematology Oncology, Surgery, orthopedic
Objective: risk factors, adverse effects
ICD-10: C49, M81, S72,