Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk

Burnet, Neil; Nasr, P.; Yip, Grace; Scaife, J.E.; House, Tony; Thomas, S J; Harris, Frances; Owen, P. Julian; Hull, Peter

doi:10.1259/bjr.20140398

Cited by 18 publications

(16 citation statements)

References 48 publications

(106 reference statements)

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“…However, recent studies have shown the efficacy of a single dose of 6–8 Gy, administered at energies between 6 and 15 MV. 133,134 Prophylactic radiation also reduces the recurrence of HO after resection of heterotopic bone, as has been extensively demonstrated in case of knee replacement surgeries. 135 Despite the predominance of RT use toward HO prophylaxis, there are side-effects associated with its use, such as, increase in bony nonunions, and radiation-induced sarcoma.…”

Section: Treatment and Prophylaxismentioning

confidence: 91%

The traumatic bone: trauma-induced heterotopic ossification

Dey

Wheatley

Cholok

et al. 2017

Translational Research

110

108

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Heterotopic ossification (HO) is a common occurrence after multiple forms of extensive trauma. These include arthroplasties, traumatic brain and spinal cord injuries, extensive burns in the civilian setting, and combat-related extremity injuries in the battlefield. Irrespective of the form of trauma, heterotopic bone is typically endochondral in structure and is laid down via a cartilaginous matrix. Once formed, the heterotopic bone typically needs to be excised surgically, which may result in wound healing complications, in addition to a risk of recurrence. Refinements of existing diagnostic modalities, like micro- and nano-CT are being adapted toward early intervention. Trauma-induced HO is a consequence of aberrant wound healing, systemic and local immune system activation, infections, extensive vascularization, and innervation. This intricate molecular crosstalk culminates in activation of stem cells that initiate heterotopic endochondral ossification. Development of animal models recapitulating the unique traumatic injuries has greatly facilitated the mechanistic understanding of trauma-induced HO. These same models also serve as powerful tools to test the efficacy of small molecules which specifically target the molecular pathways underlying ectopic ossification. This review summarizes the recent advances in the molecular understanding, diagnostic and treatment modalities in the field of trauma-induced HO.

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Section: Treatment and Prophylaxismentioning

confidence: 91%

The traumatic bone: trauma-induced heterotopic ossification

Dey

Wheatley

Cholok

et al. 2017

Translational Research

110

108

View full text Add to dashboard Cite

show abstract

“…The number of studies looking at this modern regimen are very limited and thus our literature review only yielded only a few relevant studies. Burnet et al in 2014 reported on a cohort of 34 patients who underwent RT in a single fraction of 8 Gy for the prevention of HO after traumatic acetabular fracture; 28 (82%) developed no HO, 6 (17.6%) developed clinically Brooker grade I HO, and none developedBrooker grade II-IV HO 21.…”

mentioning

confidence: 99%

A Retrospective Analysis of 287 Patients Undergoing Prophylactic Radiation Therapy for the Prevention of Heterotopic Ossification

Freije

Kushdilian

Burney

et al. 2021

Advances in Radiation Oncology

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“…This study showed that the risks from RT prophylaxis were small and that RT was safer than indometacin and substantially overlapped with the range for no prophylaxis. 107 Clearly RT offers a good control, although the risk of a RIC will be unknown for many years; in these older patients, it is likely to be very small.…”

mentioning

confidence: 99%

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

McKeown

Hatfield

Prestwich

et al. 2015

BJR

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Most radiotherapy (RT) involves the use of high doses (.50 Gy) to treat malignant disease. However, low to intermediate doses (approximately 3-50 Gy) can provide effective control of a number of benign conditions, ranging from inflammatory/proliferative disorders (e.g. Dupuytren's disease, heterotopic ossification, keloid scarring, pigmented villonodular synovitis) to benign tumours (e.g. glomus tumours or juvenile nasopharyngeal angiofibromas). Current use in UK RT departments is very variable. This review identifies those benign diseases for which RT provides good control of symptoms with, for the most part, minimal side effects. However, exposure to radiation has the potential to cause a radiation-induced cancer (RIC) many years after treatment. The evidence for the magnitude of this risk comes from many disparate sources and is constrained by the small number of long-term studies in relevant clinical cohorts. This review considers the types of evidence available, i.e. theoretical models, phantom studies, epidemiological studies, longterm follow-up of cancer patients and those treated for benign disease, although many of the latter data pertain to treatments that are no longer used. Informative studies are summarized and considered in relation to the potential for development of a RIC in a range of key tissues (skin, brain etc.). Overall, the evidence suggests that the risks of cancer following RT for benign disease for currently advised protocols are small, especially in older patients. However, the balance of risk vs benefit needs to be considered in younger adults and especially if RT is being considered in adolescents or children.

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Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk

Abstract: The risk from RT prophylaxis is small, it is safer than indometacin and substantially overlaps with the range for no prophylaxis.

Cited by 18 publications

References 48 publications

The traumatic bone: trauma-induced heterotopic ossification

The traumatic bone: trauma-induced heterotopic ossification

A Retrospective Analysis of 287 Patients Undergoing Prophylactic Radiation Therapy for the Prevention of Heterotopic Ossification

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

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