Lack of clinical evidence for postoperative radiotherapy after surgical fixation of impending or actual pathologic fractures in the long bones in patients with cancer; a systematic review

Patients with disseminated cancer and bone metastases have a limited life expectancy and therefore any treatment should have a clear beneficial effect, outweighing all possible downsides. This systematic review aims to identify and evaluate available evidence regarding function, pain, quality of life, survival and complications of postoperative radiotherapy (RT) after surgical stabilization of impending or actual pathologic fractures of the long bones due to bone metastases. A literature search resulted in two articles reporting on 64 and 110 patients of whom 55% and 28% received postoperative RT, respectively. Both studies were retrospective cohort studies and postoperative RT had been administered depending on the surgeons' choice. The first study reported better outcomes regarding function, re-interventions and survival in patients receiving postoperative RT. The second study reported no significant difference regarding complications between the two groups. The quality of the evidence was very low due to the observational character of both studies, risk of indication bias, small study sizes, use of non-standardized outcome measures, and limited statistical analyses. The current available literature is insufficient to conclude whether postoperative RT after surgical stabilization should be standard care. It is important to realize this lack of clear evidence when calling upon RT as adjuvant palliative treatment.