Insights into pelvic insufficiency fracture following pelvic radiotherapy for cervical cancer: a comparative review.
Cervical cancer
Pathobiology
Pelvic insufficiency fractures
Radiotherapy
Risk factors
Treatment
Journal
BMC women's health
ISSN: 1472-6874
Titre abrégé: BMC Womens Health
Pays: England
ID NLM: 101088690
Informations de publication
Date de publication:
23 May 2024
23 May 2024
Historique:
received:
18
09
2023
accepted:
16
04
2024
medline:
24
5
2024
pubmed:
24
5
2024
entrez:
23
5
2024
Statut:
epublish
Résumé
Radiotherapy (RT)-induced pelvic insufficiency fractures (PIF) are prevalent in patients with cervical cancer. Inconclusive studies on PIF after cervical irradiation create uncertainty. This review examined PIF after RT in cervical patients, including its pathobiology, likely locations of fractures, incidence, clinical symptoms, and predisposing factors. We further discussed study limitations and therapeutic possibilities of PIF. The following online resources were searched for relevant articles: Google Scholar and PubMed. The keywords 'pelvic insufficiency fractures', 'cervical carcinoma' and 'cervical cancer', as well as 'chemoradiotherapy', 'chemoradiation', and 'radiotherapy', were some of the terms that were used during the search. Patients with PIF report pelvic pain after radiation treatment for cervical cancer; the incidence of PIF ranges from 1.7 to 45.2%. Evidence also supports that among all patients treated with pelvic radiation, those who experienced pelvic insufficiency fractures invariably had at least one sacral fracture, making it the most frequently fractured bone in the body. Menopausal status, weight, BMI, age, and treatments and diagnosis modalities can influence PIF during radiotherapy. In conclusion, our comparative review of the literature highlights significant heterogeneity in various aspects of PIF following radiation for patients with cervical cancer. This diversity encompasses prevalence rates, associated risk factors, symptoms, severity, diagnosis methods, preventive interventions, and follow-up periods. Such diversity underscores the complexity of PIF in this population and emphasizes the critical need for further research to elucidate optimal management strategies and improve patient outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Radiotherapy (RT)-induced pelvic insufficiency fractures (PIF) are prevalent in patients with cervical cancer. Inconclusive studies on PIF after cervical irradiation create uncertainty. This review examined PIF after RT in cervical patients, including its pathobiology, likely locations of fractures, incidence, clinical symptoms, and predisposing factors. We further discussed study limitations and therapeutic possibilities of PIF.
METHODS
METHODS
The following online resources were searched for relevant articles: Google Scholar and PubMed. The keywords 'pelvic insufficiency fractures', 'cervical carcinoma' and 'cervical cancer', as well as 'chemoradiotherapy', 'chemoradiation', and 'radiotherapy', were some of the terms that were used during the search.
RESULTS
RESULTS
Patients with PIF report pelvic pain after radiation treatment for cervical cancer; the incidence of PIF ranges from 1.7 to 45.2%. Evidence also supports that among all patients treated with pelvic radiation, those who experienced pelvic insufficiency fractures invariably had at least one sacral fracture, making it the most frequently fractured bone in the body. Menopausal status, weight, BMI, age, and treatments and diagnosis modalities can influence PIF during radiotherapy.
CONCLUSIONS
CONCLUSIONS
In conclusion, our comparative review of the literature highlights significant heterogeneity in various aspects of PIF following radiation for patients with cervical cancer. This diversity encompasses prevalence rates, associated risk factors, symptoms, severity, diagnosis methods, preventive interventions, and follow-up periods. Such diversity underscores the complexity of PIF in this population and emphasizes the critical need for further research to elucidate optimal management strategies and improve patient outcomes.
Identifiants
pubmed: 38783273
doi: 10.1186/s12905-024-03099-8
pii: 10.1186/s12905-024-03099-8
doi:
Types de publication
Journal Article
Review
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
306Informations de copyright
© 2024. The Author(s).
Références
World Health Organization. Cervical Cancer. 2024b. http://www.who.int . Accessed 5 Mar 2024b.
Kasban H, El-Bendary M, Salama D. A comparative study of medical imaging techniques. Int J Inform Sci Intell Syst. 2015;4(2):37–58.
Park S-H, Kim J-C, Lee J-E, Park I-K. Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT. Radiation Oncol J. 2011;29(4):269–76.
pmcid: 3429912
doi: 10.3857/roj.2011.29.4.269
Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393(10167):169–82.
doi: 10.1016/S0140-6736(18)32470-X
pubmed: 30638582
Moreno A, et al. Pelvic insufficiency fractures in patients with pelvic irradiation. Int J Radiation Oncology* Biology* Phys. 1999;44(1):61–6.
doi: 10.1016/S0360-3016(98)00534-3
Ikushima H, et al. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol. 2006;103(3):1100–4.
pubmed: 16919711
doi: 10.1016/j.ygyno.2006.06.038
Urits I, et al. Sacral insufficiency fractures: a review of risk factors, clinical presentation, and management. Curr Pain Headache Rep. 2020;24(3):1–9.
pubmed: 31916041
doi: 10.1007/s11916-020-0834-5
Chung YK, et al. Pelvic insufficiency fractures in cervical cancer after radiation therapy: a meta-analysis and review. vivo. 2021;35(2):1109–15.
doi: 10.21873/invivo.12356
Razavian N, et al. Radiation-induced insufficiency fractures after pelvic irradiation for gynecologic malignancies: a systematic review. Int J Radiation Oncology* Biology* Phys. 2020;108(3):620–34.
doi: 10.1016/j.ijrobp.2020.05.013
Sapienza LG, et al. Pelvic insufficiency fractures after external beam radiation therapy for gynecologic cancers: a meta-analysis and meta-regression of 3929 patients. Int J Radiation Oncology* Biology* Phys. 2020;106(3):475–84.
doi: 10.1016/j.ijrobp.2019.09.012
Mathew JM, Kumar A, Puthiyedath N. Sacral insufficiency fracture after treatment for cervical cancer. Lancet Oncol. 2022;23(7):e359.
pubmed: 35772467
doi: 10.1016/S1470-2045(22)00275-3
Miyasaka Y, et al. Pelvic insufficiency fractures following carbon-ion radiotherapy for uterine carcinomas. Radiother Oncol. 2021;156:56–61.
pubmed: 33278405
doi: 10.1016/j.radonc.2020.11.030
Baxter NN, et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587–93.
pubmed: 16304072
doi: 10.1001/jama.294.20.2587
Maier GS, et al. Risk factors for pelvic insufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr. 2016;67:80–5.
pubmed: 27448040
doi: 10.1016/j.archger.2016.06.020
Bijelic R, Milicevic S, Balaban J. Risk factors for osteoporosis in postmenopausal women. Med Archives. 2017;71(1):25.
doi: 10.5455/medarh.2017.71.25-28
Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46.
pubmed: 28293453
doi: 10.5152/eurjrheum.2016.048
Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh Y.M. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:p2029.
doi: 10.2147/TCRM.S138000
Zhang Q, Cai W, Wang G, Shen X. Prevalence and contributing factors of osteoporosis in the elderly over 70 years old: an epidemiological study of several community health centers in Shanghai. Annals Palliat Med. 2020;9(2):231–8.
doi: 10.21037/apm.2020.02.09
Ramlov A, et al. Risk factors for pelvic insufficiency fractures in locally advanced cervical cancer following intensity modulated radiation therapy. Int J Radiation Oncology* Biology* Phys. 2017;97(5):1032–9.
doi: 10.1016/j.ijrobp.2017.01.026
Bliss P, Parsons C, Blake P. Incidence and possible aetiological factors in the development of pelvic insufficiency fractures following radical radiotherapy. Br J Radiol. 1996;69(822):548–54.
pubmed: 8757658
doi: 10.1259/0007-1285-69-822-548
Abe H, et al. Radiation-induced insufficiency fractures of the pelvis: evaluation with 99mTc-methylene diphosphonate scintigraphy. AJR Am J Roentgenol. 1992;158(3):599–602.
pubmed: 1739002
doi: 10.2214/ajr.158.3.1739002
Kwon JW, et al. Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI. Am J Roentgenol. 2008;191(4):987–94.
doi: 10.2214/AJR.07.3634
Verbeek DO, et al. Pelvic fractures in the Netherlands: epidemiology, characteristics and risk factors for in-hospital mortality in the older and younger population. Eur J Orthop Surg Traumatol. 2018;28(2):197–205.
pubmed: 28993913
doi: 10.1007/s00590-017-2044-3
Andrich S, et al. Health care utilization and excess costs after pelvic fractures among older people in Germany. Osteoporos Int. 2021;32(10):2061–72.
pubmed: 33839895
pmcid: 8510957
doi: 10.1007/s00198-021-05935-1
Howland WJ, Loeffler RK, Starchman DE, Johnson RG. Postirradiation atrophic changes of bone and related complications. Radiol. 1975;117(3):677–85.
O’Connor TJ, Cole PA. Pelvic insufficiency fractures. Geriatric Orthop Surg Rehabilitation. 2014;5(4):178–90.
doi: 10.1177/2151458514548895
Hopewell JW. Radiation-therapy effects on bone density. Med Pediatr Oncol. 2003;41(3):208–11.
pubmed: 12868120
doi: 10.1002/mpo.10338
Adly H, Ing S. Radiotherapy-associated pelvic insufficiency fracture treated by Romosozumab: course of L1 and L5 vertebral body CT attenuation. J Endocr Soc. 2021;5(Supplement1):A217–217.
pmcid: 8089160
doi: 10.1210/jendso/bvab048.440
Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine. 2003;70(4):287–9.
pubmed: 12951312
doi: 10.1016/S1297-319X(03)00015-0
De Smet A, Neff J. Pubic and sacral insufficiency fractures: clinical course and radiologic findings. Am J Roentgenol. 1985;145(3):601–6.
doi: 10.2214/ajr.145.3.601
Cooper K, Beabout J, Swee R. Insufficiency fractures of the sacrum. Radiology. 1985;156(1):15–20.
pubmed: 4001403
doi: 10.1148/radiology.156.1.4001403
Yamamoto K, et al. Pelvic fractures after definitive and postoperative radiotherapy for cervical cancer: a retrospective analysis of risk factors. Gynecol Oncol. 2017;147(3):585–8.
pubmed: 29055558
doi: 10.1016/j.ygyno.2017.09.035
Blomlie V, et al. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR. Am J Roentgenol. 1996;167(5):1205–10.
doi: 10.2214/ajr.167.5.8911181
Oh D, et al. Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: analysis of risk factors. Int J Radiation Oncology* Biology* Phys. 2008;70(4):1183–8.
doi: 10.1016/j.ijrobp.2007.08.005
Shih KK, et al. Pelvic insufficiency fractures in patients with cervical and endometrial cancer treated with postoperative pelvic radiation. Gynecol Oncol. 2013;128(3):540–3.
pubmed: 23262211
doi: 10.1016/j.ygyno.2012.12.021
Tokumaru S, et al. Insufficiency fractures after pelvic radiation therapy for uterine cervical cancer: an analysis of subjects in a prospective multi-institutional trial, and cooperative study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG). Int J Radiation Oncology* Biology* Phys. 2012;84(2):e195–200.
doi: 10.1016/j.ijrobp.2012.03.042
Huh SJ, et al. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol. 2002;86(3):264–8.
pubmed: 12217746
doi: 10.1006/gyno.2002.6756
Ogino I, et al. Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy. Radiother Oncol. 2003;68(1):61–7.
pubmed: 12885453
doi: 10.1016/S0167-8140(03)00128-2
Schmeler KM, et al. Pelvic fractures after radiotherapy for cervical cancer: implications for survivors. Cancer: Interdisciplinary Int J Am Cancer Soc. 2010;116(3):625–30.
doi: 10.1002/cncr.24811
Uezono H, et al. Bone injury after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors. Int J Radiat Oncol Biol Phys. 2011;81(2):S461.
doi: 10.1016/j.ijrobp.2011.06.988
Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N. Risk factors for sacral insufficiency fractures in cervical cancer after whole pelvic radiation therapy. Anticancer Res. 2019;39(1):361–7.
pubmed: 30591481
doi: 10.21873/anticanres.13120
Salcedo MP, et al. Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer: a prospective study of 239 women. Cancer. 2020;126(11):2607–13.
pubmed: 32125711
doi: 10.1002/cncr.32807
Ishikawa K, et al. Predictive factors of posttreatment fracture by definitive radiotherapy for uterine cervical cancer. Japanese J Radiol. 2021;39(1):93–9.
doi: 10.1007/s11604-020-01039-8
Ioffe YJM et al. Postradiation damage to the pelvic girdle in cervical cancer patients: is intensity-modulated radiation therapy safer than conventional radiation? Int J Gynecologic Cancer. 2014;24(4).
Andresen JR et al. Clinical outcome and revenue situation after conservative, interventional and surgical/osteosynthetic treatment of sacral insufficiency fractures. Der Unfallchirurg. 2020.
Vitzthum LK, et al. Risk of pelvic fracture with radiation therapy in older patients. Int J Radiation Oncology* Biology* Phys. 2020;106(3):485–92.
doi: 10.1016/j.ijrobp.2019.10.006
Mehmood Q, et al. Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer. Eur J Cancer Care. 2014;23(1):43–50.
doi: 10.1111/ecc.12105
Gondi V, et al. Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis. Int J Radiation Oncology* Biology* Phys. 2012;84(4):973–82.
doi: 10.1016/j.ijrobp.2012.01.064
Rotman M, Aziz H, Choi KN. Radiation damage of normal tissues in the treatment of gynecological cancers. Radiation Tolerance Normal Tissues. 1989;23:349–66.
Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. Am J Roentgenol. 2008;191(4):995–1001.
doi: 10.2214/AJR.07.3714
Kim HJ, et al. Fractures of the sacrum after chemoradiation for rectal carcinoma: incidence, risk factors, and radiographic evaluation. Int J Radiation Oncology* Biology* Phys. 2012;84(3):694–9.
doi: 10.1016/j.ijrobp.2012.01.021
Jee SH, et al. Body-mass index and mortality in Korean men and women. N Engl J Med. 2006;355(8):779–87.
pubmed: 16926276
doi: 10.1056/NEJMoa054017
Suka M, Miwa Y, Ono Y, Yanagisawa H. BMI, waist circumference, and clustering of cardiovascular risk factors in Japanese adults. Environ Health Prev Med. 2011;16(2):90–6.
pubmed: 21432223
doi: 10.1007/s12199-010-0169-7
Mori Y, et al. Effects of dose and dose-averaged linear energy transfer on pelvic insufficiency fractures after carbon-ion radiotherapy for uterine carcinoma. Radiother Oncol. 2022;177:33–9.
pubmed: 36252637
doi: 10.1016/j.radonc.2022.10.008
Kurrumeli D, et al. An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiotherapy for cervical cancer. Strahlenther Onkol. 2021;197(6):487–93.
pubmed: 33025097
doi: 10.1007/s00066-020-01690-0
Sambrook P. Philip Sambrook, Cyrus Cooper Osteoporosis is a serious public health issue. The past 10 years have seen great advances in our understanding of its epidemiology, pathophysiology, and treatment, and further advances are rapidly being made. Clinical assessment will probably evolve from decisions mainly being made on the basis of bone densitometry, to use of algorithms of absolute. Lancet. 2006;367:2010–18.
Guise TA. Bone loss and fracture risk associated with cancer therapy. Oncologist. 2006;11(10):1121–31.
pubmed: 17110632
doi: 10.1634/theoncologist.11-10-1121
Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med. 1998;338(11):736–46.
pubmed: 9494151
doi: 10.1056/NEJM199803123381107
Delmas PD, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997;337(23):1641–7.
pubmed: 9385122
doi: 10.1056/NEJM199712043372301
Riggs BL, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990;322(12):802–9.
pubmed: 2407957
doi: 10.1056/NEJM199003223221203
Kessel D, Robertson I. Interventional radiology: a survival guide e-book. Elsevier Health Sciences; 2016.
Garant M. Sacroplasty: a new treatment for sacral insufficiency fracture. J Vasc Interv Radiol. 2002;13(12):1265–7.
pubmed: 12471192
doi: 10.1016/S1051-0443(07)61976-9
Deschamps F, De Baere T. Cementoplasty of bone metastases. Diagn Interv Imaging. 2012;93(9):685–9.
pubmed: 22889809
doi: 10.1016/j.diii.2012.06.009
Frey ME, et al. Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J. 2008;8(2):367–73.
pubmed: 17981097
doi: 10.1016/j.spinee.2007.05.011
Beşe NS, et al. Pentoxifylline in the treatment of radiation-related pelvic insufficiency fractures of bone. Radiat Med. 2003;21(5):223–7.
pubmed: 14632299
Tai P, et al. Pelvic fractures following irradiation of endometrial and vaginal cancers–a case series and review of literature. Radiother Oncol. 2000;56(1):23–8.
pubmed: 10869751
doi: 10.1016/S0167-8140(00)00178-X