The Level 4 study by Holt et al found a 26% incidence of postradiation fracture in 374 patients following combined surgical resection and external beam irradiation of soft tissue sarcomas. They also found that fracture risk was increased in females, patients older than 50 years of age, and those with higher doses of irradiation (>60 Gy). The Level 4 study by Lin et al of 205 patients found a 29% incidence of fracture at 5 years followup. They found that periosteal resection was a risk factor for fracture occurrence. The use of chemotherapy as an adjuvant treatment has not been shown to increase the risk of post-radiation fracture. The approximate calculated risk of a femoral fracture for this patient is 25%.
Holt GE, Griffin AM, Pintilie M, Wunder JS, Catton C, O'Sullivan B, Bell RS. Fractures following radiotherapy and limb-salvage surgery for lower extremity soft-tissue sarcomas. A comparison of high-dose and low-dose radiotherapy. J Bone Joint Surg Am. 2005 Feb;87(2):315-9.
PMID:15687153 (Link to Abstract)
Lin PP, Schupak KD, Boland PJ, Brennan MF, Healey JH. Pathologic femoral fracture after periosteal excision and radiation for the treatment of soft tissue sarcoma. Cancer. 1998 Jun 15;82(12):2356-65.
PMID:9635528 (Link to Abstract)