Does intensity-modulated radiotherapy reduce the risk of pelvic insufficiency fractures in gynaecological cancers?

Abstract

AbstractBackgroundIncreasingly we are using a combination of surgery, chemotherapy and radiotherapy for treatment of gynaecological malignancies. Most studies in literature are concentrated on the concept of survival. There is minimal data examining the impact of these treatments on quality of life. Survival being a surrogate marker is an arbitrary end point and is of arguable significance if quality of life is not maintained. Long-term side effects of radiotherapy are debilitating and severely affect quality of life. Pelvic insufficiency fractures (PIF) are a known long-term side effect of radiotherapy. Intensity-modulated radiotherapy (IMRT) is being routinely used in the treatment of prostate and head and neck cancer. We postulated that use of IMRT in gynaecological cancers reduces the incidence of PIF.Patients and methodsWe retrospectively reviewed 10 cases of PIF treated on standard treatment. We recalculated dose volume histograms based on IMRT protocols for patients with PIF.ResultsWe found that none of the patients received any radiation at the fracture site and the total radiation received to the sacrum was lower compared with the standard treatment protocols.ConclusionsWe conclude that the feasibility of IMRT in gynaecological cancers should be further evaluated and might be an useful tool in reducing the number of PIF.