Lucas Gomes Sapienza1, Mila Pontremoli Salcedo2, Matthew Stephen Ning3, Anuja Jhingran3, Ann H Klopp3, Vinícius Fernando Calsavara4, Kathleen M Schmeler5, Maria José Leite Gomes6, Emanuel de Freitas Carvalho7, Glauco Baiocchi8. 1. Department of Internal Medicine, Michigan State University College of Human Medicine, Ascension Providence Hospital, Southfield, Michigan. Electronic address: lucasgsapienza@gmail.com. 2. Department of Obstetrics and Gynecology, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Statistics and Epidemiology, AC Camargo Cancer Center, São Paulo, Brazil. 5. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Radiation Oncology, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil. 7. Department of Urology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 8. Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil.
Abstract
PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.
PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.
Authors: Mila P Salcedo; Anil K Sood; Anuja Jhingran; Patricia J Eifel; Ann H Klopp; Revathy B Iyer; Bryan M Fellman; Camilo Jimenez; Kathleen M Schmeler Journal: Cancer Date: 2020-03-03 Impact factor: 6.860
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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
Authors: Loren K Mell; Ronghui Xu; Catheryn M Yashar; Michael T McHale; John P Einck; Jyoti Mayadev; Euyhyun Lee; Pratibha Binder; Dominique Rash; Ramez Eskander; Elena S Heide; Steven C Plaxe; Arno J Mundt; Cheryl C Saenz Journal: Int J Radiat Oncol Biol Phys Date: 2020-04-22 Impact factor: 8.013