Radiotherapy for the prophylaxis of heterotopic ossification: A systematic review and meta-analysis of randomized controlled trials

Milica Milakovic; Marko Popovic; Srinivas Raman; May Tsao; Henry Lam; Edward Chow

doi:10.1016/j.radonc.2015.05.022

Radiotherapy for the prophylaxis of heterotopic ossification: A systematic review and meta-analysis of randomized controlled trials

Radiother Oncol. 2015 Jul;116(1):4-9. doi: 10.1016/j.radonc.2015.05.022. Epub 2015 Jul 7.

Authors

Milica Milakovic¹, Marko Popovic¹, Srinivas Raman¹, May Tsao¹, Henry Lam¹, Edward Chow²

Affiliations

¹ Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
² Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada. Electronic address: edward.chow@sunnybrook.ca.

PMID: 26163090
DOI: 10.1016/j.radonc.2015.05.022

Abstract

Introduction: Heterotopic ossification (HO) involves the formation of lamellar bone in nonosseous tissue. For HO, radiotherapy has been shown to be an effective prophylactic modality.

Objective: To compare HO outcomes following radiotherapy and to investigate the comparative efficacy of preoperative versus postoperative radiotherapy.

Methods: A systematic search was conducted on Ovid MEDLINE, EMBASE and Cochrane CENTRAL. Studies were included if they were randomized controlled trials (RCTs) that included patients who were prescribed prophylactic radiation for whom relevant HO progression outcomes were reported.

Results: From a literature search of 528 articles, 12 RCTs were included. There was a statistically significant reduction in HO prevalence with multiple as opposed to single fraction radiotherapy (p=0.04), however there was no statistically significant difference when examining HO progression (p=0.34). There was no statistically significant difference in HO progression when comparing a biologically effective radiation dose (BED) of >2500cGy versus ⩽2500cGy (p=0.28). As well, no statistically significant difference existed in HO progression between postoperative versus preoperative radiation (p=0.43).

Conclusion: There was no difference between postoperative or preoperative radiotherapy in preventing HO progression. There seems to be no relationship between BED greater or less than 2500cGy and the efficacy of HO prophylaxis. Multiple fractions seem to be more effective than single fraction radiotherapy in preventing HO progression.

Keywords: Heterotopic ossification; Meta-analysis; Radiotherapy; Randomized controlled trial.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Humans
Ossification, Heterotopic / prevention & control
Ossification, Heterotopic / radiotherapy*
Postoperative Period
Radiation Dosage
Randomized Controlled Trials as Topic*