Incidence and Risk Factors for Extremity Osteoradionecrosis after Limb-Sparing Surgery and Adjuvant Radiotherapy

Area of Science:

• Oncology
• Orthopedic Surgery
• Radiation Oncology

Background:

• Osteoradionecrosis (ORN) is a significant complication of radiotherapy, predominantly studied in head and neck cancers.
• Limited research exists on ORN in patients with extremity soft tissue sarcoma (STS), a distinct clinical challenge.

Purpose of the Study:

• To investigate the incidence, clinical presentation, and risk factors of osteoradionecrosis in patients with extremity soft tissue sarcoma treated with limb-sparing surgery and radiotherapy.
• To highlight the importance of recognizing and managing ORN in this specific patient population.

Main Methods:

• Retrospective analysis of 198 patients with extremity STS who received limb-sparing surgery and adjuvant radiotherapy (2004-2017).
• Evaluation of ORN incidence, location, clinical manifestations, and correlation with radiation dose and surgical techniques.
• Comparison of characteristics between patients who developed ORN and those who did not.

Main Results:

• The incidence of extremity ORN was 3.5% (7/198), with most cases in the lower extremities.
• ORN was associated with significantly higher total radiation doses (68 Gy vs. 64 Gy) and increased intraoperative periosteal stripping (p=0.008).
• Clinical presentations included chronic ulcers, soft tissue necrosis, sinus discharge, bone nonunion, and pathological fractures.

Conclusions:

• Osteoradionecrosis is an under-recognized complication in extremity STS patients, requiring specific attention.
• Higher radiation doses and periosteal stripping are identified risk factors.
• Management involves repeat surgeries, reconstruction, or amputation, underscoring the need for vigilant surveillance and multidisciplinary care.