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Radiation Therapy for Prevention of Heterotopic Ossification about the Elbow

Strahlentherapie zur Prävention heterotoper Ossifikationen am Ellbogengelenk

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Purpose:

To evaluate the radiologic and functional outcome after prophylactic radiation therapy (RT) for prevention of heterotopic ossification (HO) about the elbow joint.

Patients and Methods:

20 patients with symptomatic HO were treated using perioperative single-dose RT of 7.0 Gy. 15 patients had excision of preexisting functionally relevant HO, and received RT for prevention of a recurrence, and five patients were treated prophylactically because of risk factors. In 13 patients RT was applied within 5 h preoperatively, seven patients received postoperative RT. The local control was evaluated by plain radiographs and the functional outcome was assessed by use of the Mayo Elbow Performance Score (MEPS).

Results:

After a mean follow-up of 43.3 months, two patients had recurrence of the HO and were treated with further surgical resection. In the remaining 18 patients no progression of the HO was observed. At follow-up, the MEPS varied from 45 to 100 with 13 patients having no functional impairment (MEPS 100). Five patients experienced a slight limitation of the elbow with an MEPS ranging from 75 to 95, and only two had persistence of marked impairment with an MEPS of 45 and 50, respectively. Adverse effects related to use of RT were observed in none of the treated cases.

Conclusion:

Pre- or postoperative RT is effective for prevention of HO about the elbow joint and can be recommended as an integral component of interdisciplinary treatment in complicated elbow fractures. At this, the use of MEPS has proven to be a feasible method for evaluation of the functional outcome.

Ziel:

Bewertung der Effektivität der prophylaktischen Strahlentherapie zur Prävention heterotoper Ossifikationen (HO) am Ellbogengelenk und Evaluierung des funktionellen Behandlungsresultats.

Patienten und Methodik:

20 Patienten wurden perioperativ mittels einer Einzeitbestrahlung mit 7,0 Gy behandelt. 15 Patienten wurden bei Exzision klinisch relevanter HO zur Rezidivprophylaxe und fünf in primärer Intention aufgrund von Risikofaktoren bestrahlt. 13 Patienten erhielten in einem Zeitraum von maximal 5 h eine präoperative Bestrahlung, und sieben Patienten wurden postoperativ behandelt. Die lokale Kontrolle wurde anhand konventioneller Übersichtsbilder bewertet; das funktionelle Ergebnis wurde mit dem Mayo Elbow Performance Score (MEPS) quantifiziert.

Ergebnisse:

Nach einem durchschnittlichen Nachbeobachtungszeitraum von 43,3 Monaten hatten zwei Patienten eine Progression der HO, bei den verbleibenden 18 Patienten waren die HO lokal kontrolliert. Zum Zeitpunkt der Nachbeobachtung wiesen 13 Patienten keinerlei Funktionsdefizite auf (Mayo Elbow Performance Score [MEPS] 100). Fünf Patienten hatten geringe bis mäßige Funktionseinschränkungen mit einem MEPS von 75–95. Bei zwei Patienten wurde ein schlechtes funktionelles Resultat mit Scores von 45 und 50 erzielt. Relevante Nebenwirkungen der Strahlentherapie wurden in keinem Fall beobachtet.

Schlussfolgerung:

Die prä- oder postoperative Strahlentherapie ist sehr effektiv zur Prävention von HO am Ellbogengelenk und sollten in die interdisziplinäre Behandlung von Komplexverletzungen mit eingebunden werden. Die Verwendung des MEPS erwies sich als ein praktikables Verfahren zur Evaluierung des funktionellen Behandlungsergebnisses.

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Authors and Affiliations

  1. Department of Radiotherapy, Klinikum Offenbach Hospital, Offenbach, Germany

    Nikolaos Zamboglou

  2. Strahlenklinik, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany

    Reinhard Heyd

Authors
  1. Reinhard Heyd
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  2. Thomas Buhleier
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  3. Nikolaos Zamboglou
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Correspondence to Reinhard Heyd.

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Heyd, R., Buhleier, T. & Zamboglou, N. Radiation Therapy for Prevention of Heterotopic Ossification about the Elbow. Strahlenther Onkol 185, 506–511 (2009). https://doi.org/10.1007/s00066-009-1968-x

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  • DOI: https://doi.org/10.1007/s00066-009-1968-x

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