Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: Analysis of risk factors
Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: Analysis of risk factors
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DOI：
10.1016/j.ijrobp.2007.08.005
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发表时间：
2008-03-15
影响因子：
7
通讯作者：
Lee, Je Ho
中科院分区：
文献类型：
--
作者：
Oh, Dongryul;Huh, Seung Jae;Lee, Je Ho
目的：探讨宫颈癌盆腔放疗后骨盆功能不全骨折(PIF)的发生率、临床特点及危险因素。方法与材料：回顾分析1998年1月至2005年8月收治的557例宫颈癌全盆放疗患者的临床资料及骨显像、CT、MRI等影像资料。PIF的5年累积发生率为19.7%。最常见的受累部位是骶骨关节。确诊时有48例(57.8%)患者出现盆腔疼痛。11例(13.3%)因疼痛剧烈而需入院或用药，其余患者经保守治疗后症状明显缓解。在单因素分析中，年龄和年龄=55岁(p<；0.001)、前后前后平行对位技术(p=0.001)、根治性治疗(p<；0.001)和放射剂量=50.4Gy(p=0.005)是PIE合并化疗的易感因素(p=0.005)。多因素分析显示，年龄55岁(P<0.001)、体重=50.4GY(P=0.04)是盆腔放疗后PIE发生的重要诱因。结论：盆腔放疗后PIF的发生并非罕见。使用多波束装置来减少照射骨盆骨的体积和剂量，有助于将骨折的风险降至最低，特别是在体重较低的老年妇女。(C)2008年爱思唯尔公司。
Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer.Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed.Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age >= 55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose >= 50.4 Gy (p = 0.005) were the predisposing factors for development of PIE Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age >= 55 years (p < 0.001), body weight = 50.4 Gy (p = 0.04) were significant predisposing factors for development of PIE.Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight. (C) 2008 Elsevier Inc.