Pelvic insufficiency fractures frequently occur following preoperative chemo‐radiotherapy for rectal cancer – a nationwide <scp>MRI</scp> study

Jørgensen, Judit; Bondeven, P.; Iversen, Lene Hjerrild; Laurberg, Søren; Pedersen, Birthe D.

doi:10.1111/codi.14224

Cited by 18 publications

(30 citation statements)

References 40 publications

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“…All patients underwent rectal resection (partial mesorectal excision (PME), total mesorectal excision (TME) or abdominoperineal excision (APE)) with curative intent from April 2011 to August 2012. The inclusion procedure and characteristics of the total cohort is previously described in detail by Jørgensen et al 2018 [7]. This study includes a sub-group of the above-mentioned nationwide study, namely all patients treated with neoadjuvant CRT at one of the participating institutions, Aarhus University Hospital.…”

Section: Methodsmentioning

confidence: 99%

“…Pelvic insufficiency fracture (PIF) is a well-known late complication to pelvic radiotherapy and can be misinterpreted clinically as local recurrence causing pain and decreased mobility. In patients with rectal cancer, the incidence of PIF is reported from 3.3% to 7.1% and recently up to 33%, depending on detection method, follow-up timing and definition [4], [6], [7]. In other cancer types such as cervical cancer the incidence has been described as high as 90% up to 3-years after radiotherapy [8], [4], [9], [10].…”

Section: Introductionmentioning

confidence: 99%

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Pelvic insufficiency fractures, dose volume parameters and plan optimization after radiotherapy for rectal cancer

Kronborg

Jørgensen

Petersen

et al. 2019

Clinical and Translational Radiation Oncology

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Pelvic insufficiency fractures (PIF) is a known but under-acknowledged late effect of pelvic radiotherapy. In rectal cancer, studies describing incidence of PIF and relation to dose volume relationships are lacking. The aim of this study was (i) to analyse dose volume histograms (DVH) from pelvic bones in patients with and without PIF, and (ii) to determine bone sparing capacity of 2 and 3 arc volumetric arc therapy (VMAT), intensity modulated radiotherapy (IMRT) and proton beam therapy (PBT), in rectal cancer patients treated with chemoradiotherapy (CRT). Material and methods: Patients treated with CRT for primary rectal cancer underwent a 3-year pelvic MRI for identification of PIFs. Bone structures were retrospectively delineated, and DVHs were recalculated. Comparative planning was done with 2 (original) and 3 arc VMAT, fixed field IMRT and PBT plans. Results: 27 patients (18 men, mean age 64 years) were included and PIFs were identified in 9 (33%), most (n = 6) had multiple fracture sites. In general, patients with PIFs received higher doses to pelvic bones, and V30 Gy to the sacroiliac joint was non-significantly higher in patients with PIF 68.5% (60.1-69.3 IQR) vs. 56% (54.1-66.6 IQR), p = 0.064. Comparative planning showed that especially 3 arc VMAT and proton beam therapy could be optimized for bone. Conclusions: Patients, treated with VMAT based CRT for rectal cancer, have high rates of PIFs after 3 years. Patients with PIFs tended to have received higher doses to sacroiliac joints. Comparative planning demonstrated most pronounced bone sparing capacity of 3 arc VMAT and with PBT having the potential to further lower doses. These results should be validated in larger and preferably prospective cohorts.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pelvic insufficiency fractures, dose volume parameters and plan optimization after radiotherapy for rectal cancer

Kronborg

Jørgensen

Petersen

et al. 2019

Clinical and Translational Radiation Oncology

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“…A prospective case-control study involving 403 rectal cancer patients was published in 2018[53]. These patients underwent MRI pelvis imaging 3 years post resection of their rectal tumour to assess for local recurrence and the presence of pelvic insufficiency fractures.…”

Section: Complications Of Radiotherapymentioning

confidence: 99%

Neoadjuvant radiotherapy for rectal cancer management

Feeney

Sehgal

Sheehan

et al. 2019

WJG

162

103

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Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone or in combination. Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery. The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes, within an intact mesorectal package, in order to minimise local recurrence. It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties. Pre-operative staging including CT thorax, abdomen, pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential. Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy. While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure, which includes patients with nodal involvement, extramural venous invasion and threatened circumferential margin. The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.

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“…High age and female gender were risk factors. 211 The risk of secondary, RT induced, cancers has been explored in several studies. Patients included in two Swedish trials, recruiting patients in the 1980s and -90s were found to have an increased risk of a second cancer, RR (95% CI) 1.85 (1.23-2.78).…”

Section: Toxicity From Radiotherapymentioning

confidence: 99%

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Erlandsson

Lörinc

Ahlberg

et al. 2019

Radiotherapy and Oncology

109

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Pelvic insufficiency fractures frequently occur following preoperative chemo‐radiotherapy for rectal cancer – a nationwide MRI study

Abstract: Preoperative CRT in the treatment of rectal cancer was associated with a 14-fold higher risk of PIFs after 3 years, whereas female gender and age above 65 years each tripled the risk of PIFs.

Cited by 18 publications

References 40 publications

Pelvic insufficiency fractures, dose volume parameters and plan optimization after radiotherapy for rectal cancer

Pelvic insufficiency fractures, dose volume parameters and plan optimization after radiotherapy for rectal cancer

Neoadjuvant radiotherapy for rectal cancer management

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

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