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Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer
Author(s) -
Mehmood Q.,
Beardwood M.,
Swindell R.,
Greenhalgh S.,
Wareham T.,
Barraclough L.,
Livsey J.,
Davidson S.E.
Publication year - 2014
Publication title -
european journal of cancer care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.849
H-Index - 67
eISSN - 1365-2354
pISSN - 0961-5423
DOI - 10.1111/ecc.12105
Subject(s) - medicine , insufficiency fracture , radiation therapy , cervical cancer , chemotherapy , surgery , incidence (geometry) , cervical insufficiency , uterine cancer , malignancy , magnetic resonance imaging , cancer , radiology , cervix , osteoporosis , physics , optics
Insufficiency fractures are recognised consequences of radiotherapy in gynaecological malignancy with reported incidences between 2.7% and 89%. We aimed to determine the incidence and risk factors for insufficiency fractures in patients receiving radical pelvic radiotherapy for uterine and cervical cancer. A case‐note review was undertaken of patients treated between J anuary 2007 and D ecember 2008. Insufficiency fractures were identified from radiographs, computed tomography and magnetic resonance images. Chi‐squared and M ann– W hitney tests were performed to determine associations between insufficiency fractures and chemotherapy, steroids and age. A total of 285 patients received pelvic radiotherapy, 137 with uterine and 148 with cervical cancer. Mean age was 59 years. A total of 144 patients received chemotherapy, 101 concurrently and 35 adjuvantly. Bone abnormalities affected 67 patients, 33 had pelvic insufficiency fractures, 12 had multiple fractures and 3 patients developed femoral head avascular necrosis. Use of chemotherapy was not associated with development of fractures ( P = 0.949). However, cervical cancer patients had a significantly higher incidence of insufficiency fractures ( P = 0.018) and bone pain ( P = 0.03) compared with uterine cancer patients. This suggests concurrent chemotherapy may be a significant factor in increasing insufficiency fractures and bone morbidity in these patients and highlights a need for further research to identify, prevent and reduce these long‐term complications.