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Title: Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria formore » Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.« less
 [1] ;  [2] ;  [3] ;  [4] ;  [5] ;  [6] ;  [7] ;  [8] ;  [9] ;  [5] ;  [10] ;  [11] ;  [12] ;  [13] ;  [14] ;  [15] ;  [16] ;  [17] ;
  1. Department of Heavy Particle Therapy and Radiation Oncology, Saga University, Saga (Japan)
  2. Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa (Japan)
  3. Radiation Oncology Department, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan)
  4. Gunma University Heavy Ion Medical Center, Maebashi (Japan)
  5. Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan)
  6. Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan)
  7. Department of Radiology, Saitama Cancer Center, Saitama (Japan)
  8. Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan)
  9. Department of Radiology, National Shikoku Cancer Center, Matsuyama (Japan)
  10. Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan)
  11. Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan)
  12. Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan)
  13. Proton Medical Research Center and Tsukuba University, Tuskuba (Japan)
  14. Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita (Japan)
  15. Department of Radiology, Showa University School of Medicine, Tokyo (Japan)
  16. Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan)
  17. Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan)
Publication Date:
OSTI Identifier:
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 84; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States