What is the incidence and non-union rate of radiation-associated fractures? – A systematic review of the literature

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-11-06 DOI:10.1016/j.radonc.2024.110617

Argen Omurzakov, Sanjeev Rampam, Marcos R. Gonzalez, Santiago A. Lozano-Calderon

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引用次数: 0

Abstract

Background

Radiation-associated fractures (RAFs) are a challenging complication in oncologic patients, yet their incidence remains unknown and optimal management lacks consensus.

Aim

This review aimed to evaluate the incidence of RAFs in the trunk, pelvis, and extremities as well as non-union rates of surgical and non-surgical treatment.

Materials and methods

A systematic review of PubMed and Embase databases was conducted. The study was registered on PROSPERO (ID: CRD42024513017). Studies were included if they reported RAFs in oncologic populations, had a sample size of at least five patients, and provided extractable data on RAF incidence or number. The STROBE checklist was utilized for evaluation of study quality. For eligible studies, quantitative analyses were conducted to determine weighted incidence of RAF and fracture non-union.

Results

Thirty-five studies comprising 9,980 patients treated with radiation therapy were included. The weighted incidence of RAFs was calculated to be 6.5% across 8,061 patients. The weighted incidence of femoral RAF was 5.2%, while pelvic RAF incidence was 17.1%. Non-union rates after initial treatment varied from 4% to 100%, with an overall weighted incidence of 48%. Treatments included intramedullary nailing, fixation with screws/plate, prosthetic replacement, conservative treatment, and amputation, with varying success rates.

Conclusion

This review highlights RAFs as a significant complication of radiation therapy, with a weighted incidence of 6.5% and a non-union rate of 48%. Advanced radiation techniques have reduced RAF occurrences, but non-union remains a challenge, necessitating tailored treatment strategies. Further research is needed to optimize RAF management and improve patient outcomes.

查看原文本刊更多论文

辐射相关骨折的发生率和非愈合率是多少？- 文献系统回顾。

背景：目的：本综述旨在评估躯干、骨盆和四肢辐射相关骨折（RAFs）的发生率以及手术和非手术治疗的非愈合率：对 PubMed 和 Embase 数据库进行了系统回顾。该研究已在 PROSPERO 上注册（ID：CRD42024513017）。如果研究报告了肿瘤人群中的 RAF，样本量至少为五名患者，并提供了 RAF 发生率或数量的可提取数据，则被纳入研究。研究质量评估采用 STROBE 检查表。对符合条件的研究进行定量分析，以确定RAF和骨折不愈合的加权发生率：结果：共纳入 35 项研究，包括 9,980 名接受放射治疗的患者。经计算，8,061 名患者的 RAF 加权发生率为 6.5%。股骨RAF的加权发生率为5.2%，骨盆RAF的发生率为17.1%。初次治疗后的不愈合率从4%到100%不等，总体加权发生率为48%。治疗方法包括髓内钉、螺钉/钢板固定、假体置换、保守治疗和截肢，成功率各不相同：本综述强调 RAF 是放射治疗的一个重要并发症，加权发生率为 6.5%，不愈合率为 48%。先进的放射技术降低了RAF的发生率，但不愈合仍是一项挑战，因此有必要制定有针对性的治疗策略。要优化 RAF 管理并改善患者预后，还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.