Abstract
PurposeThe aim of this study was to investigate whether bone mineral density (BMD) as measured in planning computed tomographies (CTs) by a new method is a risk factor for pelvic insufficiency fractures (PIF) after radio(chemo)therapy (R(C)T) for cervical cancer.Methods62 patients with cervical cancer who received definitive or adjuvant radio(chemo)therapy between 2013 and 2017 were reviewed. The PIF were detected on follow-up magntic resonance imaging (MRI). The MRI of the PIF patients was registered to the planning CT and the PIF contoured. On the contralateral side of the fracture, a mirrored structure of the fracture was generated (mPIF). For the whole sacral bone, three lumbar vertebrae, the first and second sacral vertebrae, and the PIF, we analyzed the BMD (mg/cm3), V50Gy, Dmean, and Dmax.ResultsOut of 62 patients, 6 (9.7%) had a fracture. Two out of the 6 patients had a bilateral fracture with only one of them being symptomatic. PIF patients showed a significantly lower BMD in the sacral and the lumbar vertebrae (p < 0.05). The BMD of the contoured PIF, however, when comparing to the mPIF, did not reach significance (p < 0.49). The difference of the V50Gy of the sacrum in the PIF group compared to the other (OTH) patients, i.e. those without PIF, did not reach significance.ConclusionThe dose does not seem to have a relevant impact on the incidence of PIF in our patients. One of the predisposing factors for developing PIF after radiotherapy seems to be the low BMD. We presented an easy method to assess the BMD in planning CTs.
Highlights
Definitive or adjuvant radio(chemo)therapy have both become an essential component in the treatment of cervical cancer, especially in locally advanced cervical cancer (LACC), by reducing the recurrence of the disease and improving the overall survival rate for these patients [1,2,3,4,5]
Patients were treated with external beam radiation therapy (EBRT) alone or EBRT and concurrent chemotherapy. 33 patients were treated with definitive radiochemotherapy, 22 with adjuvant radiochemotherapy, 5 with definitive radiotherapy, and 2 patients were treated with adjuvant radiotherapy. 31 patients received additional high-dose-rate intracavitary brachytherapy (HDR-ICBT). 43 patients received an EBRT boost to the primary tumor (PT) and/or the lymph nodes (LN), with 34 of them receiving a simultaneous integrated boost (SIB), 13 a sequential boost (SB), and amongst them, 4 patients received both boost techniques
All of them were detected in follow-up magntic resonance imaging (MRI) as pelvic insufficiency fractures (PIF) and all of them were located in the lateral mass of the sacral bone
Summary
Definitive or adjuvant radio(chemo)therapy have both become an essential component in the treatment of cervical cancer, especially in locally advanced cervical cancer (LACC), by reducing the recurrence of the disease and improving the overall survival rate for these patients [1,2,3,4,5]. The aim should be to reach a total EBRT + brachytherapy dose of ≥85–90 Gy. Additional brachytherapy as part of the adjuvant treatment should only be considered if a well-defined limited area is at high risk of local recurrence (i.e., vagina, parametrium) [4, 6]. Additional brachytherapy as part of the adjuvant treatment should only be considered if a well-defined limited area is at high risk of local recurrence (i.e., vagina, parametrium) [4, 6] Through these advances in treatment, the late effects of pelvic radiation have drawn more attention. Very few studies have been able to evaluate bone mineral density (BMD) as a risk factor for the occurrence of PIF. Established methods of assessing bone mineral density are associated with additional radiation exposure to the patient
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
