Pelvic Insufficiency Fractures After External Beam Radiation Therapy for Gynecologic Cancers: A Meta-analysis and Meta-regression of 3929 Patients

Sapienza, Lucas Gomes; Salcedo, Mila Pontremoli; Ning, Matthew S.; Jhingran, Anuja; Klopp, Ann H.; Calsavara, Vinícius Fernando; Schmeler, Kathleen M.; Gomes, Maria José Leite; Carvalho, Emanuel de Freitas; Baiocchi, Glauco

doi:10.1016/j.ijrobp.2019.09.012

Cited by 54 publications

(61 citation statements)

References 39 publications

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“…Next, we evaluated sites frequently involved by PIF. Our findings showed that 65.5% (19/29) of patients developed PIF in the sacrum; trends which were reported in previous studies on photon RT [24,25,28]. The sacrum might be the most frequent region of PIF, regardless of the modalities used for external beam RT (EBRT).…”

Section: Discussionsupporting

confidence: 79%

“…Log-rank tests showed that the incidences of PIF were significantly higher in subgroups with BMI lower than 18.5 and a current smoking status. In contrast, there was no difference between subgroups stratified by age (≥50 and <50 years), although previous studies have reported that older women were likely to have insufficiency fractures [24]. These differences in results may be attributed to the fact that sacral PIF was the focus of our study, while most previous studies evaluated PIFs in all pelvic regions.…”

Section: Discussioncontrasting

confidence: 78%

“…Although little is known on PIF after C-ion RT for UCs, there are 2 meta-analyses regarding PIF after photon RT for UCC: Sapienza LG et al showed a crude incidence of PIF following definitive RT as 21% (95% CI: 14-30%) [24]; Razavian N et al showed the same as 9.4% (95% CI: 6.8-12.4%) [25]. Among studies included in these meta-analyses, PIF incidences were widely different.…”

Section: Discussionmentioning

confidence: 99%

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Pelvic insufficiency fractures following carbon-ion radiotherapy for uterine carcinomas

Miyasaka

Okonogi

Fukahori

et al. 2021

Radiotherapy and Oncology

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Pelvic insufficiency fractures following carbon-ion radiotherapy for uterine carcinomas

Miyasaka

Okonogi

Fukahori

et al. 2021

Radiotherapy and Oncology

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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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“…Meanwhile, the late adverse events associated with RT has drawn more attention, including RT-induced insufficiency fracture [2]. RTinduced IF is a relatively common complication for cervical cancer, previous studies showed that the 2-year cumulative incidences of IF after pelvic RT ranged from 14 to 36.9% [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Radiation-induced occult insufficiency fracture or bone metastasis after radiotherapy for cervical cancer? The nomogram based on quantitative apparent diffusion coefficients for discrimination

et al. 2020

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Background Radiation-induced insufficiency fractures (IF) is frequently occult without fracture line, which may be mistaken as metastasis. Quantitative apparent diffusion coefficient (ADC) shows potential value for characterization of benign and malignant bone marrow diseases. The purpose of this study was to develop a nomogram based on multi-parametric ADCs in the differntiation of occult IF from bone metastasis after radiotherapy (RT) for cervical cancer. Methods This study included forty-seven patients with cervical cancer that showed emerging new bone lesions in RT field during the follow-up. Multi-parametric quantitative ADC values were measured for each lesion by manually setting region of interests (ROIs) on ADC maps, and the ROIs were copied to adjacent normal muscle and bone marrow. Six parameters were calculated, including ADCmean, ADCmin, ADCmax, ADCstd, ADCmean ratio (lesion/normal bone) and ADCmean ratio (lesion/muscle). For univariate analysis, receiver operating characteristic curve (ROC) analysis was performed to assess the performance. For combined diagnosis, a nomogram model was developed by using a multivariate logistic regression analysis. Results A total of 75 bone lesions were identified, including 48 occult IFs and 27 bone metastases. There were significant differences in the six ADC parameters between occult IFs and bone metastases (p < 0.05), the ADC ratio (lesion/ muscle) showed an optimal diagnostic efficacy, with an area under ROC (AUC) of 0.887, the sensitivity of 95.8%, the specificity of 81.5%, respectively. Regarding combined diagnosis, ADCstd and ADCmean ratio (lesion/muscle) were identified as independent factors and were selected to generate a nomogram model. The nomogram model showed a better performance, yielded an AUC of 0.92, the sensitivity of 91.7%, the specificity of 96.3%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 86.7%, respectively. Conclusions Multi-parametric ADC values demonstrate potential value for differentiating occult IFs from bone metastasis, a nomogram based on the combination of ADCstd and ADCmean ratio (lesion/muscle) may provide an improved classification performance.

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Pelvic Insufficiency Fractures After External Beam Radiation Therapy for Gynecologic Cancers: A Meta-analysis and Meta-regression of 3929 Patients

Cited by 54 publications

References 39 publications

Pelvic insufficiency fractures following carbon-ion radiotherapy for uterine carcinomas

Pelvic insufficiency fractures following carbon-ion radiotherapy for uterine carcinomas

Ten Commandments for the Diagnosis of Bone Tumors

Radiation-induced occult insufficiency fracture or bone metastasis after radiotherapy for cervical cancer? The nomogram based on quantitative apparent diffusion coefficients for discrimination

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