Risk of pelvic fractures in older women following pelvic irradiation
Risk of pelvic fractures in older women following pelvic irradiation
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DOI：
10.1001/jama.294.20.2587
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发表时间：
2005-11-23
影响因子：
120.7
通讯作者：
Virnig, BA
中科院分区：
文献类型：
--
作者：
Baxter, NN;Habermann, EB;Virnig, BA
骨盆骨折，包括髋部骨折，是老年妇女发病率和死亡率的主要来源。虽然治疗性盆腔放疗可能会增加此类骨折的风险，但这种影响尚未得到研究。（肛门癌、宫颈癌或直肠癌）的女性比没有接受放射治疗的盆腔恶性肿瘤女性有更高的骨盆骨折率。设计、设置和参与者我们进行了一项回顾性队列研究，使用监测、流行病学、和最终结果（SEER）癌症登记数据链接到医疗保险索赔数据。从1986年到1999年，共有6428名年龄在65岁及以上的女性被诊断为盆腔恶性肿瘤。我们比较了接受放射治疗的妇女（n = 2855）与未接受放射治疗的妇女（n = 3573）的结果。为了评估选择偏倚的影响，我们还评估了照射对非照射部位骨质疏松性骨折的影响（手臂和脊柱）。主要结果测量我们评估了放射对骨盆骨折发生率随时间的影响，结果接受放射治疗的女性比未接受放射治疗的女性更容易发生骨盆骨折，放射治疗（累积5年骨折率，肛门癌女性为14.0% vs 7.5%，宫颈癌女性为8.2% vs 5.9%，直肠癌女性为11.2% vs 8.7%）;差异具有统计学意义，大多数骨折（90%）为髋部骨折。我们控制了潜在的混杂因素，包括年龄、种族、癌症分期和地理位置。放疗的影响因癌症部位而异：肛门癌的治疗与骨盆骨折的高风险相关（风险比，3.16; 95%置信区间，1.48-6.73）;比宫颈癌（风险比，1.66; 95%置信区间，1.06-2.59）;或直肠癌（风险比，1.65; 95%置信区间，1.33-2.05）。照射组和非照射组的手臂或脊柱骨折发生率无统计学显著差异（危害比，1.15; 95%置信区间，0.89-1.48）。结论盆腔照射大大增加了老年妇女骨盆骨折的风险。考虑到骨盆骨折的高基线风险，这一发现尤其值得关注。
Context Pelvic fractures, including hip fractures, area major source of morbidity and mortality in older women. Although therapeutic pelvic irradiation could increase the risk of such fractures, this effect has not been studied.Objective To determine if women who undergo pelvic irradiation for pelvic malignancies (anal, cervical, or rectal cancers) have a higher rate of pelvic fracture than women with pelvic malignancies who do not undergo irradiation.Design, Setting, and Participants We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims data. A total of 6428 women aged 65 years and older diagnosed with pelvic malignancies from 1986 through 1999 were included. We compared results for women who did (n = 2855) Vs did not (n = 3573) undergo radiation therapy. To assess the influence of selection bias, we also evaluated the effect of irradiation on osteoporotic fractures in nonirradiated sites (arm and spine).Main Outcome Measure We evaluated the effect of irradiation on the incidence of pelvic fractures over time, and adjusted for potential confounders using a proportional hazards model.Results Women who underwent radiation therapy were more likely to have a pelvic fracture than women who did not undergo radiation therapy (cumulative 5-year fracture rate, 14.0% vs 7.5% in women with anal cancer, 8.2% vs 5.9% in women with cervical cancer, and 11.2% vs 8.7% in women with rectal cancer); the difference was statistically significant and most fractures (90%) were hip fractures. We controlled for potential confounders including age, race, cancer stage, and geographic location. The impact of irradiation varied by cancer site: treatment for anal cancer was associated with a higher risk of pelvic fractures (hazard ratio, 3.16; 95% confidence interval, 1.48-6.73); than for cervical cancer (hazard ratio, 1.66; 95% confidence interval, 1.06-2.59); or rectal cancer (hazard ratio, 1.65; 95% confidence interval, 1.33-2.05). No statistically significant difference was found in the rate of arm or spine fractures between the irradiated and nonirradiated groups (hazard ratio, 1.15; 95% confidence interval, 0.89-1.48).Conclusions Pelvic irradiation substantially increases the risk of pelvic fractures in older women. Given the high baseline risk of pelvic fracture, this finding is of particular concern.