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, Louis; Xu, Haoping; Foy, Jean‐Philippe; Amessis, M.; Malhaire, Caroline; Cao, Kim; Rochefordière, Anne de la; Kirova, Youlia

doi:10.1259/bjr.20160885

Cited by 34 publications

(40 citation statements)

References 42 publications

(57 reference statements)

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“…Aging is also an important risk factor. A higher pelvic fracture risk after RT has been reported in many different studies in patients who are older than 50, 55, 60, 65, or 70 . Our study also proved that in a multivariable Cox model, patients older than 60 years had a higher pelvic fracture risk (HR: 1.086, CI: 1.076‐1.097, P < 0.001).…”

Section: Discussionsupporting

confidence: 85%

“…One study reported that the reduction rate in volumetric bone mineral density among patients who received C/T after 1 year was 15.9% over the L1‐L2 spine and 10.4% over the femoral neck . 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 .…”

Section: Discussionmentioning

confidence: 99%

“…30 However, C/T was not a significant risk factor for pelvic fracture in several studies. 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.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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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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“…It is therefore essential to distinguish radiation-induced fractures from metastases, which may require biopsies and initiation of treatments such as chemotherapy. These two lesions can generally be distinguished by alternately performing pelvic CT and MRI follow-ups [9]. MRIs can detect early changes of sacral insufficiency with a proved sensitivity at or near 100%.…”

Section: Discussionmentioning

confidence: 99%

Sacral insufficiency fracture following rectal cancer treatment – case report

Pikuła¹,

Pikuła²,

Pastuszak³

2020

J Pre Clin Clin Res.

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Introduction and Objective. Locally advanced rectal cancers witha high risk of recurrence need multimodal treatment Rusing neoadiuvant preoperative chemoradiotherapy or preoperative radiotherapy. Both rectal cancer surgery and the additional chemoradiotherapy or radiotherapy may cause late sequelae. The aim of the study is to present a clinical situation in which a pelvic recurrence of rectal cancer has to be distinguished from therapy side effects. Insufficiency fracture (IF) is one of the therapy side-effects. It can cause pain and decrease mobility and it is a well-known late complication to pelvic radiotherapy, but can be misinterpreted as a local recurrence. Conclusions. It is extremely important to distinguish IF from metastases, which may require biopsies and initiation of potentially toxic treatments such as chemotherapy. MRI and CT scans are complementary modalities to make an accurate diagnosis of IF.

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“…8). 15,16 In this situation, both CT and MRI can be diagnostic showing the fractures in the absence of true bone destruction. Vascular malignancies such as epithelioid hemangioendothelioma and angiosarcoma of bone can be multifocal in up to two thirds of cases simulating metastatic disease.…”

Section: Commandment 7: Not All Multiple Bone Lesions Are Metastases mentioning

confidence: 99%

Ten Commandments for the Diagnosis of Bone Tumors

Davies

Lalam

Woertler

et al. 2020

Semin Musculoskelet Radiol

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The diagnosis of tumors and tumorlike lesions of bone is a routine part of both general and specialist radiologic practices. The spectrum of disorders ranges from the small incidental lesion to the potentially life-limiting malignancies whether primary or secondary. In this review, authored by experts from several European orthopaedic oncology centers, we present a collection of pieces of advice in the form of 10 commandments. Adherence in daily practice to this guidance should help minimize adverse patient experiences and outcomes.

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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

Cited by 34 publications

References 42 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

Sacral insufficiency fracture following rectal cancer treatment – case report

Ten Commandments for the Diagnosis of Bone Tumors

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