Insufficiency fracture after radiation therapy

Abstract

Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

Diagnosis of Insufficiency Fracture After Radiotherapy in Patients With Cervical Cancer: Contribution of Technetium Tc 99m-Labeled Methylene Diphosphonate Single-Photon Emission Computed Tomography/Computed Tomography

“…Moreover, patients might undergo a biopsy or be treated by inappropriate chemotherapy or RT to their weakened bone. 2,3,10,24 It is important to note that not all pelvic IFs are due to radiation. According to many studies, the most important risk factor for pelvic IF is osteoporosis.…”

“…Other causes include rheumatoid arthritis, prolonged use of corticosteroids, hyperparathyroidism, and radiotherapy (RT). 2,3 Pelvic RT has been considered an essential method for the treatment of cervical cancer. Although radiation-induced IFs were considered a relatively rare adverse event after pelvic RT in patients with cervical cancer, several clinical investigations have shown that IFs are more common than previously thought.…”

The best of both worlds — managing the cancer, saving the bone

“…In addition to the possibility of inducing hypo-gonadism, radiation therapy might also directly damage bone, which results in insufficiency fractures that are common in the pelvis in gynaecological, prostate, anal and rectal cancers, and in the ribs 96 . The development of an expanding series of radiopharmaceuticals might help to alleviate some of these important limitations.…”

Stress Fractures of Tibia Treated with Ilizarov External Fixator

“…Stress fractures can also develop after radiotherapy in patients who undergo long-term treatment with corticosteroids, sodium fluoride, etidronic acid and methotrexate [7,[12][13][14][15].…”

“…Zła ma nia po wol ne mo gą po wstać też u pa cjen tów po ra dio te ra pii, za ży wa ją cych prze wle kle le ki ta kie jak gli ko kor ty ko ste ro idy, flu orek so du, kwas eti dryno wy i me to trek sat [7,[12][13][14][15]. turned to work.…”