Pelvic Insufficiency Fracture after Pelvic Irradiation in Uterine Cervix Cancer

Huh, Seung Jae; Kim, Bokyoung; Kang, Min Kyu; Lee, Jeong Eun; Lim, Do Hoon; Park, Won; Shin, Seong Sik; Ahn, Yong-Chan

doi:10.1006/gyno.2002.6756

Cited by 72 publications

(42 citation statements)

References 14 publications

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“…Radiation-induced occlusion of bone microvascularization also results in ischaemia, which participates in the formation of insufficiency fractures. 35 Radiation-induced fractures generally require symptomatic management by Steps 1 (nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol) or 2 (weak opioids) analgesics and rest. 11,[36][37][38][39][40][41] In some cases, pain control requires specialized management and/or hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Bazire

Foy

et al. 2017

BJR

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Objective: To summarize the results of pelvic insufficiency fracture (PIF) incidence in patients with anal or gynaecological cancer treated by pelvic intensitymodulated radiation therapy (IMRT). Methods: The clinical and morphological (CT and/or pelvic MRI) characteristics of patients treated by IMRT at our institution between 2007 and 2014 were analyzed. The global incidence of PIF after external beam radiotherapy and the impact of tumour site (gynaecological or anal cancer) were determined. A dosimetric study was then performed to compare patients with and without pelvic fracture. Results: 341 patients were treated by IMRT for gynaecological or anal cancer between 2007 and 2014. 15 patients experienced at least 1 pelvic fracture after external beam radiotherapy, corresponding to an overall incidence of 4.4%. Age and menopausal status were correlated with an increased fracture risk (p 5 0.0274 and p , 0.0001, respectively). The site of the primary tumour (gynaecological or anal canal) was not associated with an excess fracture risk. The median maximum dose received at the fracture site was 50.3 Gy (range: 40.8-68.4 Gy). Conclusion: The incidence of pelvic fracture after IMRT is low, but is higher after the age of 50 and in patients who are postmenopausal. Pre-treatment evaluation of bone density by bone densitometry and phosphorus-calcium assessment could be useful prior to the management of these patients. Advances in knowledge: Pelvic fractures are a frequent complication after radiotherapy. The influence of IMRT and clinical characteristics were evaluated in this study.

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Section: Discussionmentioning

confidence: 99%

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Bazire

Foy

et al. 2017

BJR

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“…It is concidered that missing of bone mass occur because of the bone osteoblastic formation and bone vasculature damages (14)(15)(16). Ionizing radiation inhibits osteoblast proliferation, increases sensitivity to agents that induce apoptosis, and reduces collagen production (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Radiation on Bone Mineral Density of Radiology Workers Depending on The Device They Use

Kunt

Dayıoğlu

2011

ELECTRON J GEN MED

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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.…”

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confidence: 99%

Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers

Wei

Jung

Manzano

et al. 2016

Radiotherapy and Oncology

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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 Irradiation in Uterine Cervix Cancer

Cited by 72 publications

References 14 publications

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

The Effects of Radiation on Bone Mineral Density of Radiology Workers Depending on The Device They Use

Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers

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