TY - JOUR
T1 - Pelvic insufficiency fractures in patients with cervical and endometrial cancer treated with postoperative pelvic radiation
AU - Shih, Karin K.
AU - Folkert, Michael R.
AU - Kollmeier, Marisa A.
AU - Abu-Rustum, Nadeem R.
AU - Sonoda, Yukio
AU - Leitao, Mario M.
AU - Barakat, Richard R.
AU - Alektiar, Kaled M.
PY - 2013/3/1
Y1 - 2013/3/1
N2 - Objective There is an increased awareness of pelvic insufficiency fractures (PIF) as a potential morbidity of pelvic radiotherapy (RT). The purpose of this study was to determine the incidence of PIF and assess prognostic factors, including intensity-modulated RT (IMRT), in gynecologic oncology patients treated with postoperative pelvic RT. Methods We performed a retrospective review of all patients with endometrial or cervical carcinoma who received postoperative pelvic RT at our institution during 2000-2008. Patients who received definitive or palliative RT were excluded. Results A total of 222 patients were identified, of whom 11 (5%) developed PIF at a median time of 11.5 months (range, 5.5-87.3 months) from RT completion. The 5-year actuarial rate was 5.1% (95% CI 3.3-6.9). In patients with osteoporosis, the 5-year rate was 15.6% compared with 2.9% for those without (P = 0.01). Similarly, patients who were on prior hormone-replacement therapy (HRT) had a higher rate (14.8% vs 4.1%, P = 0.009). The median body-mass index (BMI) for patients who developed PIF was significantly lower than those who didn't (25.9 vs 27.2, P = 0.016). The rate of PIF was 4.9% whether patients received IMRT or conventional RT. Conclusions The 5-year risk of PIF for postoperative pelvic RT in cervical and endometrial cancer is 5.1%. Women with history of osteoporosis, prior HRT, or low BMI need to be counseled about the risk of PIF. The use of IMRT did not decrease PIF, but further studies are needed to determine if a dose/volume relationship exists between RT and PIF.
AB - Objective There is an increased awareness of pelvic insufficiency fractures (PIF) as a potential morbidity of pelvic radiotherapy (RT). The purpose of this study was to determine the incidence of PIF and assess prognostic factors, including intensity-modulated RT (IMRT), in gynecologic oncology patients treated with postoperative pelvic RT. Methods We performed a retrospective review of all patients with endometrial or cervical carcinoma who received postoperative pelvic RT at our institution during 2000-2008. Patients who received definitive or palliative RT were excluded. Results A total of 222 patients were identified, of whom 11 (5%) developed PIF at a median time of 11.5 months (range, 5.5-87.3 months) from RT completion. The 5-year actuarial rate was 5.1% (95% CI 3.3-6.9). In patients with osteoporosis, the 5-year rate was 15.6% compared with 2.9% for those without (P = 0.01). Similarly, patients who were on prior hormone-replacement therapy (HRT) had a higher rate (14.8% vs 4.1%, P = 0.009). The median body-mass index (BMI) for patients who developed PIF was significantly lower than those who didn't (25.9 vs 27.2, P = 0.016). The rate of PIF was 4.9% whether patients received IMRT or conventional RT. Conclusions The 5-year risk of PIF for postoperative pelvic RT in cervical and endometrial cancer is 5.1%. Women with history of osteoporosis, prior HRT, or low BMI need to be counseled about the risk of PIF. The use of IMRT did not decrease PIF, but further studies are needed to determine if a dose/volume relationship exists between RT and PIF.
KW - Cervical cancer
KW - Endometrial cancer
KW - IMRT
KW - Insufficiency fracture
KW - Pelvic radiation
UR - http://www.scopus.com/inward/record.url?scp=84873725969&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84873725969&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2012.12.021
DO - 10.1016/j.ygyno.2012.12.021
M3 - Article
C2 - 23262211
AN - SCOPUS:84873725969
SN - 0090-8258
VL - 128
SP - 540
EP - 543
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -