Catherine Okoukoni1, David M Randolph2, Emory R McTyre2, Andy Kwok3, Ashley A Weaver4, A William Blackstock2, Michael T Munley5, Jeffrey S Willey6. 1. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA. 2. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA. 3. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA. 4. Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA. 5. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA. 6. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA. Electronic address: jwilley@wakehealth.edu.
Abstract
BACKGROUND AND PURPOSE: Anal cancer patients treated with radiation therapy (RT) have an increased risk of hip fractures after treatment. The mechanism of these fractures is unknown; however, femoral fractures have been correlated with cortical bone thinning. The objective of this study was to assess early changes in cortical bone thickness at common sites of femoral fracture in anal cancer patients treated with intensity modulated radiation therapy (IMRT). MATERIALS AND METHODS: RT treatment plans and computed tomography (CT) scans from 23 anal cancer patients who underwent IMRT between November 2012 and December 2014 were retrospectively reviewed. Cortical thickness (Ct.Th) was mapped at homologous vertices within the proximal femur using pre-RT and post-RT (≤4months) CT scans. The bone attenuation measurements were collected at homologous locations within the trabecular bone of the right femoral neck (FN). The percent change in Ct.Th and trabecular bone mineral density (trBMD) were assessed. FN cortical thinning was correlated to RT dose using linear regression. A logistic model for dose dependent cortical thinning was constructed. RESULTS: Twenty-two patients were analyzed. Significant post-treatment cortical thinning was observed in the intertrochanteric crest, subcapital and inferior FN (p<0.05). FN volume receiving ≥40Gy (V40Gy) was a significant predictor of focal cortical thinning ≥30% (p=0.03). A significant decrease in FN trBMD was observed (-6.4% [range -34.4 to 3.3%]; p=0.01). CONCLUSION: Significant early decrease in Ct.Th and trBMD occurs at the FN in patients treated with RT for anal cancer. FN V40Gy was predictive of clinically significant focal FN cortical thinning. Copyright Â
BACKGROUND AND PURPOSE:Anal cancerpatients treated with radiation therapy (RT) have an increased risk of hip fractures after treatment. The mechanism of these fractures is unknown; however, femoral fractures have been correlated with cortical bone thinning. The objective of this study was to assess early changes in cortical bone thickness at common sites of femoral fracture in anal cancerpatients treated with intensity modulated radiation therapy (IMRT). MATERIALS AND METHODS: RT treatment plans and computed tomography (CT) scans from 23 anal cancerpatients who underwent IMRT between November 2012 and December 2014 were retrospectively reviewed. Cortical thickness (Ct.Th) was mapped at homologous vertices within the proximal femur using pre-RT and post-RT (≤4months) CT scans. The bone attenuation measurements were collected at homologous locations within the trabecular bone of the right femoral neck (FN). The percent change in Ct.Th and trabecular bone mineral density (trBMD) were assessed. FN cortical thinning was correlated to RT dose using linear regression. A logistic model for dose dependent cortical thinning was constructed. RESULTS: Twenty-two patients were analyzed. Significant post-treatment cortical thinning was observed in the intertrochanteric crest, subcapital and inferior FN (p<0.05). FN volume receiving ≥40Gy (V40Gy) was a significant predictor of focal cortical thinning ≥30% (p=0.03). A significant decrease in FN trBMD was observed (-6.4% [range -34.4 to 3.3%]; p=0.01). CONCLUSION: Significant early decrease in Ct.Th and trBMD occurs at the FN in patients treated with RT for anal cancer. FN V40Gy was predictive of clinically significant focal FN cortical thinning. Copyright Â
Authors: Michael Farris; Emory R McTyre; Catherine Okoukoni; Greg Dugan; Brendan J Johnson; A William Blackstock; Michael T Munley; J Daniel Bourland; J Mark Cline; Jeffrey S Willey Journal: Radiat Res Date: 2018-05-08 Impact factor: 2.841
Authors: Kristen M Beavers; Michael P Walkup; Ashley A Weaver; Leon Lenchik; Stephen B Kritchevsky; Barbara J Nicklas; Walter T Ambrosius; Joel D Stitzel; Thomas C Register; Sue A Shapses; Anthony P Marsh; W Jack Rejeski Journal: J Bone Miner Res Date: 2018-08-07 Impact factor: 6.741
Authors: Megan M Pendleton; Shannon R Emerzian; Saghi Sadoughi; Alfred Li; Jennifer W Liu; Simon Y Tang; Grace D O'Connell; Jean D Sibonga; Joshua S Alwood; Tony M Keaveny Journal: JBMR Plus Date: 2021-09-26