Non-traumatic vertebral fractures in patients with locally advanced esophageal cancer: a previously unreported, unrecognized problem

Abstract

Recent studies suggest cancer therapy may compromise bone integrity. What is the rate of vertebral fractures among patients who have received trimodality therapy (radiation, chemotherapy, and surgery) for locally advanced esophageal cancer? This single-institution, retrospective study attempted to answer this question, focusing on 337 patients who had received trimodality therapy for locally advanced esophageal cancer between 1996 and 2005. Reports of serial radiographs were reviewed to identify vertebral fractures. Duration of follow-up was gathered for all esophageal cancer patients with the intention of calculating fracture incidence rates. Fracture-related symptoms, types of intervention and fracture recurrence were also gleaned from the clinical records. First-time fractures were identified in 47 patients, and 45 of these were new since the cancer diagnosis. Thus, the first-time fracture incidence rate from the time of cancer diagnosis was 12 fractures per 100 patient years. The median time from cancer diagnosis to fracture was 9 months. Fifteen (33%) patients were symptomatic. Acknowledging that a retrospective study can inadvertently result in information omission, we report that pain medications were started in only seven patients (16%), and osteoporosis medication in only six (13%). Two patients were hospitalized, and two underwent vertebroplasty. The median survival after fracture diagnosis was 36 months. This report describes a seemingly high fracture incidence rate that requires confirmation. If confirmed, future studies should focus on identifying risk factors and optimal strategies for the prevention and treatment of vertebral fractures in patients with esophageal cancer.

Insufficiency fracture after radiation therapy

“…After pelvic RT, low lumbar spines are often involved ( Fig. 2 ) and non-traumatic vertebral fracture after RT in patients with esophageal cancer was reported [ 22 ].…”

Cost-effectiveness of zoledronic acid in the prevention of skeletal-related events in patients with bone metastases secondary to advanced renal cell carcinoma: application to France, Germany, and the United Kingdom

“…Given that 34% of vertebral fractures in cancer patients [14] and 33% in the general population [15] are symptomatic and 7% [14] of fractures in cancer patients and approximately 8% in the general population [15] are managed in the hospital, the cost of treating a pathological vertebral fracture was assumed to be only 7% of the DRG costs. For example, in France the DRG cost of a hospitalized vertebral fracture was € 5,326.…”

“…For example, a patient with spinal cord compression was assumed to experience a reduction in quality of life of 80% from the baseline score of 0.76 for a period of 1 month. The negative impact of vertebral fractures on utility was assumed to occur only among those patients who were symptomatic (34%), as reported in patients with vertebral fractures in another cancer [14] and in the general population [15]. …”