Radiation therapy for the prevention of heterotopic ossification: Efficacy and toxicity of single fraction radiotherapy

Abstract

Numerous nonmalignant diseases can be treated with radiation therapy (RT). Among them, Heterotopic Ossification (HO) is a benign condition resulting from several causes that can be successfully managed with ionizing radiation. More often seen in the hip area after major surgical procedures, HO is of major concern as it can lead to functional disorders, pain and even to joint ankylosis. We retrospectively analyzed the outcome of therapeutic irradiation for the prevention of HO in 14 patients treated in our hospital between 2005 and 2011. All patients were irradiated with a dose ranging from 7 to10 Gy in a single fraction for prevention of HO after surgery. After a median follow up of 126 months (range 96 – 156 months) none of our patients developed HO. Impaired wound healing or other post surgery complications like trochanteric nonunion were not observed. A single fraction of RT seems to be a sufficient, cost effective and safe treatment regimen. In our study we report excellent results as none of our patients developed HO.

Bilateral hip heterotopic ossification with sciatic nerve compression on a paediatric patient–An individualized surgical approach: A case report

“…It is considered useful for inactivating the high mitotic rate of the pluripotent osteoprogenitor cells recruited by the inflammatory cascade and their differentiation into osteoblasts and chondrocytes[ 6 ]. Low-dose radiation therapy administered preoperatively or less than 72 h postoperatively represents an effective treatment[ 7 ], not only in reducing the size of NHO lesions[ 8 ] but also the risk of recurrence[ 9 ], with minimal side effects[ 10 ].…”

Single-dose radiation therapy without additional surgery as a treatment for heterotopic ossification developing after transfemoral amputation, a case report

“…13,24 Because of low radiation doses, it is generally considered safe with adverse effects occurring rarely. 29 Risk for secondary malignancies is minimal with one noted case reported in the literature of radiation-induced sarcoma reported after prophylactic radiation therapy for HO. 30 Because of this, careful consideration should be given when considering radiation therapy to young patients.…”

Fifteen years’ experience of radiation therapy for resected advanced heterotopic ossification following motor vehicle accidents: outcome and side effects

“…The patients are followed up at the orthopedic clinic by X-ray or osseous CT every 3-6 months to exclude recurrence or malunion postoperatively during the first 2 years. Physiotherapy and occupational therapy are routinely continued per the patient clinical status [12][13][14][15][16].…”

“…Using a 3-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) can reduce infertility by keeping the radiation to the testis and ovaries within the acceptable tolerance doses. Proper shielding and avoidance of -radiation beam to pass through-organs at risk (OAR) are essential maneuvers to achieve that goal [14][15][16].…”