Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

Oh, Dongryul; Huh, Seung Jae; Nam, Heerim; Park, Won; Han, Yoon Hee; Lim, Do Hoon; Ahn, Yong Chan; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho

doi:10.1016/j.ijrobp.2007.08.005

Cited by 118 publications

(140 citation statements)

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“…The combination of these effects results in a reduction in the bone mineral density (BMD) in patients undergoing pelvic RT (43). The incidence of IF seems to be higher than expected, although there are many discrepancies in the various study (5,(10)(11)(12)(13)(14)(44)(45)(46), probably due to the differences in the follow-up, as the choice of imaging may increase the detection of asymptomatic IFs. One study reported 89% of patients had findings compatible with IF after pelvic RT using magnetic resonance imaging (47), while another study reported 34% using bone scintigraphy (48).…”

Section: Discussionmentioning

confidence: 99%

“…Original Article 3D bone texture analysis as a potential predictor of radiationinduced insufficiency fractures been identified include post-menopausal state, older age, chemotherapy and female sex (8,11,13,14). Texture analysis (TA) is able to quantify image heterogeneities that may not be appreciated with the naked eye, and represents a method based on mathematical analysis for the evaluation of gray-level intensity and for the position of the pixels within the images, providing "texture features", that represent a quantitative measure of various imaging techniques (15).…”

Section: Respectively the Risk Factors For Rt-induced Ifs That Havementioning

confidence: 99%

“…Recently, radiation therapy (RT) has been recognized as a risk factor for IFs (5) in many malignancies (6)(7)(8)(9)(10), ranging from 9% to 11.2% in rectal (11), 8.2% to 45.2% in cervical (12)(13)(14), and up to 6.8% (10) in prostate cancer,…”

Section: Introductionmentioning

confidence: 99%

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3D bone texture analysis as a potential predictor of radiation-induced insufficiency fractures

Nardone¹,

Tini²,

Croci³

et al. 2018

Quant. Imaging Med. Surg.

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Background: The aim of our work is to assess the potential role of texture analysis (TA), applied to computed tomography (CT) simulation scans, in relation to the development of insufficiency fractures (IFs) in patients undergoing radiation therapy (RT) for pelvic malignancies. Methods:We analyzed patients undergoing pelvic RT from Jan-2010 to Dec-2016, 31 of whom had developed IFs of the pelvis. We analyzed CT simulation scans using LifeX Software © , and in particular we selected three regions of interest (ROI): L5 body, the sacrum and both the femoral heads. The ROI were automatically contoured using the treatment planning software Raystation © . TA parameters included parameters from the gray-level histogram, indices from sphericity and from the matrix of GLCM (gray level co-occurrence matrix). The IFs patients were matched (1:1 ratio) with control patients who had not developed IFs, and were matched for age, sex, type of tumor, menopausal status, RT dose and use of chemotherapy. Univariate and multivariate analyses (logistic regression) were used for statistical analysis.Results: Significant TA parameters on univariate analysis included both parameters from the histogram distribution, as well from the matrix of GLCM. On logistic regression analysis the significant parameters Conclusions: In our experience, 3D-bone CT TA can be used to stratify the risk of the patients to develop radiation-induced IFs. A prospective study will be conducted to validate these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Respectively the Risk Factors For Rt-induced Ifs That Havementioning

confidence: 99%

See 1 more Smart Citation

3D bone texture analysis as a potential predictor of radiation-induced insufficiency fractures

Nardone¹,

Tini²,

Croci³

et al. 2018

Quant. Imaging Med. Surg.

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“…8 ), and whilst the association is well documented in gynaecological and colorectal studies with a 5-year incidence of 8.2-19.7 %, there is a paucity of data in prostate cancer (Oh et al 2008 ). The data available for prostate cancer suggests that insuffi ciency fractures are rare in this group with a 5-year incidence of 6.8 % (Igdem et al 2010 ).…”

Section: Bonesmentioning

confidence: 99%

Female Pelvis: Genital Organs

Forstner

Cunha²

2015

Imaging of Complications and Toxicity Following Tumor Therapy

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Medical Radiology-Diagnostic Imaging is a unique series that aims to document the most innovative technologies in all fi elds within diagnostic imaging and interventional radiology, thereby informing the physician in practice of the latest advances in diagnostic imaging and percutaneous imageguided minimally invasive procedures. Th e contents are intended to cover all organs, and all modern imaging techniques and image-guided treatment modalities, with special emphasis on applications in clinical practice. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. Medical Radiology -Radiation Oncology is a unique series that aims to document the most innovative technologies in all fi elds within radiology, thereby informing the physician in practice of the latest advances in diagnostic and treatment techniques. Th e contents range from contemporary statements relating to management for various disease sites to explanations of the newest techniques for tumor identifi cation and of mechanisms for the enhancement of radiation eff ects, with the emphasis on maximizing cure and minimizing complications. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. AbstractA precise knowledge of antineoplastic drugs is an indispensable basis for the care of patients with cancer. The mechanisms of action and resistance, cross-resistance patterns, pharmacodynamics and pharmacokinetics, pharmacological interaction, and last but not least potential adverse effects should be part of this knowledge. As contemporary cancer care requires interdisciplinary and multiprofessional structures, the radiologist is an important a...

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“…marrow replacement [4][5][6][7]. Several reports have shown BMD reduction after radiation to the pelvis, cervical vertebrae, and thoracic rib [8,9]. Advances in 3D Conformal Radiation Therapy, Intensity Modulated Radiation Therapy (IMRT), and Volumetric Modulated Arc Therapy (VMAT) have improved dose delivery accuracy, increased dose to target, reduced treatment time, and avoided integral dose of radiation to organs at risk (OAR) including lungs, heart, kidneys, and spinal cord.…”

mentioning

confidence: 99%

Bone Mineral Density Loss in Thoracic and Lumbar Vertebrae Following Radiation for Abdominal Cancers

Jung

Wei

Sehgal³

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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a b s t r a c tPurpose: To investigate the relationship between abdominal chemoradiation (CRT) for locally advanced cancers and bone mineral density (BMD) reduction in the vertebral spine. Materials and methods: Data from 272 patients who underwent abdominal radiation therapy from January 1997 to May 2015 were retrospectively reviewed. Forty-two patients received computed tomography (CT) scans of the abdomen prior to initiation and at least twice after radiation therapy. Bone attenuation (in Hounsfield unit) (HU) measurements were collected for each vertebral level from T7 to L5 using sagittal CT images. Radiation point dose was obtained at each mid-vertebral body from the radiation treatment plan. Percent change in bone attenuation (D%HU) between baseline and post-radiation therapy were computed for each vertebral body. The D%HU was compared against radiation dose using Pearson's linear correlation. Results: Abdominal radiotherapy caused significant reduction in vertebral BMD as measured by HU. Patients who received only chemotherapy did not show changes in their BMD in this study. The D%HU was significantly correlated with the radiation point dose to the vertebral body (R = À0.472, P < 0.001) within 4-8 months following RT. The same relationship persisted in subsequent follow up scans 9 months following RT (R = À0.578, P < 0.001). Based on the result of linear regression, 5 Gy, 15 Gy, 25 Gy, 35 Gy, and 45 Gy caused 21.7%, 31.1%, 40.5%, 49.9%, and 59.3% decrease in HU following RT, respectively. Our generalized linear model showed that pre-RT HU had a positive effect (b = 0.830) on determining post-RT HU, while number of months post RT (b = À0.213) and radiation point dose (b = À1.475) had a negative effect. A comparison of the predicted versus actual HU showed significant correlation (R = 0.883, P < 0.001) with the slope of the best linear fit = 0.81. Our model's predicted HU were within ±20 HU of the actual value in 53% of cases, 70% of the predictions were within ±30 HU, 81% were within ±40 HU, and 90% were within ±50 HU of the actual post-RT HU. Four of 42 patients were found to have vertebral body compression fractures in the field of radiation. Vertebral body insufficiency and compression fractures are most commonly caused by osteoporosis, an age-related and systemic skeletal disorder characterized by compromised bone strength and low bone mineral density [1]. Although, most fractures are asymptomatic, the degree of BMD loss, location of the fracture, and secondary osteoporosis from underlying medical condition including chemotherapy may make an asymptomatic, stable fracture more prone to progressive collapse causing pain, loss of mobility, and spinal cord compression [2]. The overall morbidity of vertebral body compression fractures is significant, and women diagnosed with compression fractures have a 15% higher mortality rate than matched controls [3].Irradiation of normal, non-malignant bone results in small vessel damage leading to microcirculatory occlusion, marrow hypocellularity from death of osteo...

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Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

Cited by 118 publications

References 31 publications

3D bone texture analysis as a potential predictor of radiation-induced insufficiency fractures

3D bone texture analysis as a potential predictor of radiation-induced insufficiency fractures

Female Pelvis: Genital Organs

Bone Mineral Density Loss in Thoracic and Lumbar Vertebrae Following Radiation for Abdominal Cancers

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