Premium
Pelvic insufficiency fractures frequently occur following preoperative chemo‐radiotherapy for rectal cancer – a nationwide MRI study
Author(s) -
Jørgensen J. B.,
Bondeven P.,
Iversen L. H.,
Laurberg S.,
Pedersen B. G.
Publication year - 2018
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14224
Subject(s) - medicine , colorectal cancer , radiation therapy , multivariate analysis , prospective cohort study , cancer , surgery
Aim The aim of this prospective case–control study was to evaluate the rate of pelvic insufficiency fractures ( PIF s) in Denmark using MRI at the 3‐year follow‐up. All patients had rectal cancer and had undergone surgery with or without preoperative chemo‐radiotherapy ( CRT ). Method Patients registered with primary rectal cancer in the Danish Colorectal Cancer Group database, who underwent rectal cancer resection from April 2011 through August 2012, were invited to participate in a national MRI study aiming to detect local recurrence and evaluate quality of the surgical treatment. Pelvic MRI including bone‐specific sequences 3 years after treatment was obtained. The primary outcome was the rate of PIF s; secondary outcome was risk factors of PIF s evaluated in multivariate analysis. Results During the study period, 890 patients underwent rectal cancer surgery. Of these, 403 patients were included in the MRI study and had a 3‐year follow‐up MRI . PIF s were detected in 49 (12.2%; 95% CI 9.0–15.4) patients by MRI . PIF s were detected in 39 patients (33.6%; 95% CI 24.9–42.3) treated with preoperative CRT compared to 10 (3.5%; 95% CI 1.3–5.6) non‐irradiated patients ( P < 0.001). In a multivariate analysis female gender ( OR = 3.52; 95% CI 1.7–7.5), age above 65 years ( OR = 3.20; 95% CI 1.5–6.9) and preoperative CRT ( OR = 14.20; 95% CI 6.1–33.1) were significant risk factors for PIF s. Conclusion Preoperative CRT in the treatment of rectal cancer was associated with a 14‐fold higher risk of PIF s after 3 years, whereas female gender and age above 65 years each tripled the risk of PIF s.