Pelvic Bone Complications After Radiation Therapy of Uterine Cervical Cancer: Evaluation with MRI

Kwon, Jong Won; Huh, Seung Jae; Yoon, Young Cheol; Choi, Sang‐Hee; Jung, Ji‐Yeon; Oh, Dongryul; Choe, Bong-Keun

doi:10.2214/ajr.07.3634

Cited by 139 publications

(140 citation statements)

References 35 publications

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“…A significant relationship was observed between treatment with radiotherapy and the occurrence of posttreatment fractures, which supports earlier studies demonstrating an increased risk of fracture in patients with NHL of bone, who were treated with radiation, particularly in high doses [33,46]. Other studies have also shown fractures to occur multiple years after radiation treatment and some investigators have suggested that fracture risk does not decrease over time [4,26,31,37]. Risk of fracture in our study did not appear to be related to the age or sex of the patient.…”

Section: Discussionsupporting

confidence: 82%

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ibrahim

Haughom

Fillingham

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Non-Hodgkin's lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy.Questions/purposes The objective of this study was to compare patients treated for NHL of bone with and without radiation in terms of (1) overall survival; (2) pretreatment complications; (3) posttreatment complications; and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. Methods A retrospective analysis of all patients with biopsy-proven NHL of bone diagnosed at our institution between 1985 and 2013 was undertaken; 70 patients met our criteria for inclusion with minimum followup of 6 months (median, 55 months; range, 10-219 months). Overall survival at 5 and 10 years was estimated and compared between two groups of patients: one group treated with systemic therapy alone (chemotherapy, rituximab; 46 patients [66%]) and the other with combined modality therapy (systemic therapy and radiotherapy; 24 patients [34%]). During the period in question, indications for radiotherapy included bulky disease, an abbreviated course of systemic therapy, and an incomplete response to systemic therapy. Patients not meeting these criteria generally received systemic therapy alone. With the available sample size, it was estimated that a difference in survival of approximately 30% would have to be present for detection with 80% power (a = 0.05, b = 0.2, n = 70, D = 30%). Pretreatment and posttreatment complications occurring in both patient groups were retrospectively reviewed with special emphasis on fracture healing after treatment. MSTS scores were obtained for 45 patients with appendicular tumors at a median followup of 42 months (range, 10-215 months). Results With the data available, no difference in KaplanMeier survivorship was observed between patients treated with and without radiation at 5 years (98%; 95% confidence interval [CI], 93%-100% versus 95%; 95% CI, 85%-100%; p = 0.281). Patients who were treated with radiation were

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Section: Discussionsupporting

confidence: 82%

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ibrahim

Haughom

Fillingham

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…7 The estimated incidence of pelvic insufficiency fracture (PIF) is between 10% and 29%. [8][9][10][11] Physicians must be aware of this complication that can impair the patient quality of life and must be distinguished from bone metastasis.…”

Section: Introductionmentioning

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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“…The pelvic bones sustain radiation injury, varying in severity from radiation osteitis, stress fractures, and osteonecrosis to acute pathologic fractures in a dose dependent manner, with a threshold dose of approximately 3000 cGy [3,5,9,14]. Radiotherapy has also reportedly caused accelerated degenerative arthritis, leading to substantial pain and disability [7,19].…”

Section: Introductionmentioning

confidence: 99%

Tantalum Acetabular Cups Provide Secure Fixation in THA after Pelvic Irradiation at Minimum 5-year Followup

Joglekar

Rose

Lewallen

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Pelvic radiation has been commonly used to treat gastrointestinal, genitourinary, or hematopoietic malignancies. Conventional THA in these patients reportedly have high rates of fixation failure. Although secure short-term fixation reportedly occurs with trabecular metal implants following pelvic radiation, it is unclear whether the fixation is durable. Questions/purposes We determined the survival of trabecular metal acetabular components in patients having THA following pelvic radiation and assessed function and radiographic loosening. Methods We retrospectively reviewed 29 patients with prior pelvic radiation who had 34 arthroplasties using trabecular metal acetabular components from 1998 and 2005. The mean pelvic radiation dose was 6300 cGy. We collected the following data: patient demographics, surgery and implant information, clinical and radiographic followup, and tumor and radiotherapy related details. We obtained Harris hip scores (HHS) on all patients. Ten patients died of disease prior to 5 years and two patients were excluded, leaving 17 patients (22 hips) with a minimum of 5 years of clinical (mean, 78 months; median, 71; range, 57-116) and radiographic (mean, 73; median, 65; range, 51-116) followup.

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Pelvic Bone Complications After Radiation Therapy of Uterine Cervical Cancer: Evaluation with MRI

Abstract: Radiation-induced pelvic insufficiency fractures are a frequent complication of radiation therapy for uterine cervical cancer. Osteolysis and avascular necrosis of the femoral head were also diagnosed using MRI after radiation therapy.

Cited by 139 publications

References 35 publications

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

Is Radiation Necessary for Treatment of Non-Hodgkin's Lymphoma of Bone? Clinical Results With Contemporary Therapy

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

Tantalum Acetabular Cups Provide Secure Fixation in THA after Pelvic Irradiation at Minimum 5-year Followup

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