Do you recommend treatment of the entire extent of the hardware and/or bone when treating a bone metastasis that has received pre-irradiation surgical stabilization?

In the era where imaging like MRI, CT scan, or PETCT is routinely performed, we have not been chasing entire hardware and only treating image based disease with a generous margin. I would not worry about microscopic disease along the entire hardware when the goal and endpoint is palliation.

A systematic review in 2015 reported a lack of clinical evidence for postoperative radiotherapy after surgical fixation of pathologic long bone fractures, finding only two articles, both of which were retrospective cohort studies. However, radiotherapy is often given in this clinical scenario, especially in patients with better prognosis who might be expected to benefit from a lower risk of tumor progression or implant failure. One should consider treating the entire extent of the hardware based on the retrospective review from Epstein-Peterson, who found greater RT coverage of the surgical hardware significantly reduced the risk of local failure (p=0.03). The authors reported 14/82 (17%) of patients had a local failure, with 11 (79%) of th...