There is no clear evidence for the universal use of radiotherapy after surgery to treat fractures in patients with metastatic bone cancer, according to a recent study.
In an analysis in which postoperative radiotherapy (PORT) was administered in 197 out of 526 patients after surgery, the treatment did not lower the risk of surgery failure, noted lead author Jessica Ehne, MD, of the Karolinska Institute in Stockholm, Sweden, and colleagues.
“Unexpectedly, our findings suggest a possible hazard associated with PORT, particularly in prosthesis cases,” the group wrote. The study was published on February 6 in the Journal of Bone Oncology.
In patients with metastatic bone disease who experience fractures in long bones (femur or humerus), surgery is considered a first-line treatment, the authors explained. The two main approaches are either stabilizing the remaining bone with an osteosynthesis or replacing the affected bone segments with a prosthesis.
PORT is a common clinical treatment used worldwide after surgery and is thought to reduce tumors and prevent implant failure, which is a “clinical catastrophe” for these frail patients, the group noted. Despite being widely used and theoretically appealing, however, evidence on the clinical practice of PORT is weak, the team wrote.
To bridge the gap, the researchers assessed whether PORT (external beam radiotherapy), delivered at the standard doses and fraction schemes, provides clinical benefit in terms of reducing the risk of reoperations and implant failure in patients.
The group analyzed outcomes among a total of 526 patients who underwent 552 surgeries for metastases of the major long bones between January 2000 and June 2024. The one-year survival among the group was 36%, and 21% survived for two years or more. Most patients had hematological malignancy (111), breast cancer (110), lung cancer (91), or prostate cancer (84), and 47 patients had kidney cancer.
A graphical abstract illustrating the study.Journal of Bone Oncology
PORT was administered in 197 of the cases, on average, six weeks after surgery. Of these, 33 cases (6%) required revision to fix, replace, or remove part (or all) of the original implant, and the cumulative incidence of failure was higher in the PORT group (p = 0.038), according to the results.
In addition, when the researchers divided the cases into subgroups depending on surgical method, they found PORT had no effect in the osteosynthesis group and was significantly associated with a worse outcome in the prosthesis group.
The study authors stopped short of suggesting discontinuing the use of radiotherapy completely, and they noted that the analysis supports its use in patients with a long expected remaining survival and who underwent osteosynthesis. They added that the study highlights the need for further research in the field, preferably as a prospective randomized trial.
“As therapies not clearly adding to quality of life should be avoided when caring for palliative patients, we would advise to use PORT only in selected cases,” Ehne and colleagues concluded.
The full study is available here.