Pelvic insufficiency fractures in patients with pelvic irradiation

Moreno, Araceli; Clemente, J. Ruiz; Crespo, Concepción; Martı́nez, Antonio; Navarro, Manuel; Fernández, Luis García; Minguell, Jorge; Vazquez, Gabriel A.; Andreu, Francisco Javier

doi:10.1016/s0360-3016(98)00534-3

Cited by 82 publications

(46 citation statements)

References 18 publications

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“…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. 11,12 The management of osteoporosis is particularly important in these patients who are postmenopausal treated with radiotherapy.…”

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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“…Such damage leads to a spectrum of bone changes from mild osteopenia to osteoradionecrosis with an increased risk of in-field fractures. These fractures are common and clinically significant, particularly in patients receiving radiotherapy in the pelvic region (2)(3)(4)(5), and pelvic fractures are a substantial cause of morbidity and mortality in the elderly (6,7). Understanding the mechanisms behind these adverse effects of radiation on bone and identifying new treatments for such bone disorders is imperative to improve the quality of life for these patients.…”

Section: Pth1-34 or Wnt Agonist As Possible Therapy For Radiation-indmentioning

confidence: 99%

PTH1–34 Blocks Radiation-induced Osteoblast Apoptosis by Enhancing DNA Repair through Canonical Wnt Pathway

Chandra¹,

Lin

Zhu³

et al. 2015

Journal of Biological Chemistry

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Background: PTH1-34 alleviates radiation-induced osteoporosis in a preclinical radiotherapy model. Results: PTH1-34 attenuates radiation damage on osteoblasts by increasing Ku70 amount, accelerating DNA repair, and suppressing osteoblast apoptosis. Pathway analyses identify canonical Wnt pathway as an important mediator. Conclusion: PTH1-34 blocks radiation-induced osteoblast apoptosis through activation of ␤-catenin. Significance: PTH1-34 or Wnt agonist could be possible therapy for radiation-induced osteoporosis.

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“…MRI findings are nonspecific but helpful in showing early medullary edema, fracture lines, and the absence of a soft tissue mass [9]. Extensive bone resorption attributable to insufficiency fracture has been described in the pubis, ribs, and clavicle [11,18,21,26], but not in the sacrum as noted in this case.…”

Section: Discussion and Treatmentmentioning

confidence: 55%