Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer

Mehmood, Q.; Beardwood, M; Swindell, Ric; Greenhalgh, Susan; Wareham, T; Barraclough, Lisa H; Livsey, Jacqueline E; Davidson, Susan E

doi:10.1111/ecc.12105

Cited by 21 publications

(12 citation statements)

References 36 publications

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“…However, C/T was not a significant risk factor for pelvic fracture in several studies . Combining C/T with RT may cause a higher pelvic fracture rate based on a study of gynecology malignancy . In our study, C/T was a significant factor in single variable analysis but become insignificant after multivariable adjustment.…”

Section: Discussioncontrasting

confidence: 56%

“…30,32,38 Combining C/T with RT may cause a higher pelvic fracture rate based on a study of gynecology malignancy. 39 In our study, C/T was a significant factor in single variable analysis but become insignificant after multivariable adjustment. In the subgroup analyses of the RT group, patients with C/T had a higher risk of pelvic fracture compared to the control.…”

Section: Discussionmentioning

confidence: 45%

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Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study

et al. 2019

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To determine whether radiotherapy ( RT ) can increase pelvic fracture risk in rectal cancer survivors. Rectal cancer patients who underwent curative surgery between 1996 and 2011 in Taiwan were retrospectively studied using the National Health Insurance Research Database ( NHIRD ) of Taiwan. ICD ‐9 Codes 808, 805.4‐805.7, 806.4‐806.7, and 820 (including pelvic, sacrum, lumbar, and femoral neck fracture) were defined as pelvic fracture. Propensity scores for RT , age, and sex were used to perform one‐to‐one matches between the RT and non‐ RT group. Risks of pelvic and arm fractures were compared by multivariable Cox regression. Of the 32 689 patients, 7807 (23.9%) received RT , and 1616 suffered from a pelvic fracture (incidence rate: 1.17/100 person‐years). The median time to pelvic fracture was 2.47 years. After matching, 6952 patients each in the RT and non‐ RT groups were analyzed. RT was associated with an increased risk of pelvic fractures in the multivariable Cox model (hazard ratio ( HR ): 1.246, 95% confidence interval ( CI ): 1.037‐1.495, P = 0.019) but not with arm fractures ( HR : 1.013, 95% CI : 0.814‐1.259, P = 0.911). Subgroup analyses revealed that RT was associated with a higher pelvic fracture rate in women ( HR : 1.431, 95% CI : 1.117‐1.834) but not in men, and the interaction between sex and RT was significant ( P = 0.03). The HR of pelvic fracture increased 2‐4 years after RT ( HR : 1.707, 95% CI : 1.150‐2.534, P = 0.008). An increased risk of pelvic fracture is noted in rectal cancer survivors, especially women, who receive RT .

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 45%

Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study

et al. 2019

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“…Osteonecrosis (or avascular necrosis) is a potentially painful and disabling bone disease that involves the death of bone tissue [ 1 , 2 ]. Risk factors for osteonecrosis include fractures [ 3 – 5 ], radiation [ 6 , 7 ], corticosteroids [ 8 , 9 ], excess alcohol consumption [ 10 ], and a large number of medical conditions [ 1 , 2 , 11 – 13 ]. The incidence of osteonecrosis in general populations is uncertain because there have been few large, population-based studies and because these few studies primarily estimated the prevalence of osteonecrosis and the incidence of particular types of osteonecrosis [ 14 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of osteonecrosis in general populations is uncertain because there have been few large, population-based studies and because these few studies primarily estimated the prevalence of osteonecrosis and the incidence of particular types of osteonecrosis [ 14 – 19 ]. The incidence has not been comprehensively assessed in risk groups, as previous studies considered only one risk group or a limited number of risk factors [ 5 – 7 , 14 , 15 , 20 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of osteonecrosis among older adults in Sweden

Bergman

Nordström

2019

Osteoporos Int

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Summary This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Introduction The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. Methods In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). Results The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% ( n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69–8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59–8.99), dialysis (SIR, 6.65; 95% CI, 5.62–7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70–7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. Conclusions Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Electronic supplementary material The online version of this article (10.1007/s00198-018-04826-2) contains supplementary material, which is available to authorized users.

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“…1) Whereas PIF was previously considered a minor complication of radiotherapy for uterine cervical cancer, recent studies have found a higher prevalence than was previously thought. [2][3][4] PIFs cause severe pelvic pain and can be extremely detrimental to patients' quality of life. Although several researchers have reported the incidence of radiationinduced PIFs and their risk factors, [5][6][7] the disabling impact of such injuries on the activities of daily life has thus far been rarely investigated.…”

Section: Introductionmentioning

confidence: 99%

Walking Disability in Patients with Pelvic Insufficiency Fracture after Radiotherapy for Uterine Cervical Cancer

Kido

Yoshida

Shimoda

et al. 2016

PRM

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Radiotherapy is an essential component of curative or palliative therapy for patients with uterine cervical cancer. Although advances in radiotherapy have led to longer survival, survivors may consequently be at risk of pelvic insufficiency fracture (PIF). We retrospectively reviewed medical records and clinical outcomes to assess the impact of PIF on walking disability. Methods: Between January 2002 and December 2009, 145 uterine cancer patients treated with radiotherapy in our hospital were reviewed. Among these, 15 patients (10.3%) were diagnosed with PIF. The types of fractures were identified according to the AO/OTA classification system. Medical records were examined to establish the time to first diagnosis of PIF, the type of fracture, and clinical outcomes. Disability was assessed using Barthel index mobility scores. Results: The median time to PIF detection was 16 months. Of the 15 patients with PIF, 14 had type B fractures (7 cases of B2 and 7 cases of B3) and 1 had a type C fracture. Among 11 patients with pelvic pain, 6 achieved pain control but 5 patients with bilateral lesions in the posterior arch or lateral compression of the sacrum developed pain that finally resulted in walking disability and a lower performance status. Conclusions: PIF causes severe motor disturbance in patients with unstable fracture types. Routine imaging checkups were useful during the 5 years after completion of radiotherapy; in nine patients the fracture progressed for longer than 1 year. In cancer rehabilitation for PIF patients, continuous assessment is essential for predicting walking disability.

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Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer

Cited by 21 publications

References 36 publications

Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study

Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study

Epidemiology of osteonecrosis among older adults in Sweden

Walking Disability in Patients with Pelvic Insufficiency Fracture after Radiotherapy for Uterine Cervical Cancer

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