Extremity sarcoma - post-op bone constraints

[Gfunk6]

Elizabeth Baldini (Dana Farber) has published and presented excellent guidelines for post-op sarcoma XRT bone constraints to minimize the risk of fracture. I used to have one of her presentations loaded on "My ASTRO" but it seems to have mysteriously disappeared.

Could someone who has access to these constrains online or via article please post them to this thread for posterity? Thank you.

---

Members don't see this ad.

 

[rymd]

Here's a paper that I've referenced quite a bit https://practicalradonc.com/article/S1879850015003112/abstract

The gist is - avoid circumferential 50Gy dose to the femur (though sometimes that's not possible) and fracture risk is higher if the surgeon exposes the bone and strips the periosteum.
At our institution, if they're gonna strip the periosteum, we discuss prophylactic fixation.

 

[evilbooyaa]

I would also be interested in the above.

I generally do V50 not going circumferential (per paper above) as well as V50 of (non-femoral neck) femur < 50%.

Completely different constraints for femoral neck.

 

[Gfunk6]

I am actually referring to hard quantitative guidelines for extremity bones in general (e.g. to the tune of Vx where x is a number in Gray). Circumferential radiation is not straightforward to quantify and I want to know about general bone constraints not exclusively weight bearing ones.

 

[Gfunk6]

OK, after some rummaging I found the numbers published by Baldini but not the source.

Here they are (for individual bones):

1.. V40 < 67%
2. Mean dose < 39 Gy
3. Minimize volume receiving > 59 Gy

 

[evilbooyaa]

OK, after some rummaging I found the numbers published by Baldini but not the source.

Here they are (for individual bones):

1.. V40 < 67%
2. Mean dose < 39 Gy
3. Minimize volume receiving > 59 Gy

Oh. I mean if that's all you were going for.... thought you meant like a table individualized for each bone.

https://www.astro.org/uploadedFiles/_MAIN_SITE/Meetings_and_Education/ASTRO_Meetings/2017/Annual_Refresher_Course/Content_Pieces/Sarcomas-Baldini.pdf

Slide 69:

https://www.redjournal.org/article/S0360-3016(08)03854-6/abstract