Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI.
OBJECTIVE
The purpose of this study was to assess the prevalence and distribution of radiation-induced insufficiency fractures and to investigate other bony complications of the female pelvis associated with radiation therapy using MR images.


METHODS
Two radiologists retrospectively evaluated pelvic MR images of 510 patients (mean age, 54.7 years) who underwent pelvic irradiation for uterine cervical cancer for the presence and location of insufficiency fractures by consensus. We calculated the cumulative prevalence of pelvic insufficiency fractures on the basis of their results. In addition, we identified other associated bony complications of the female pelvis by reviewing the MR images.


RESULTS
Insufficiency fractures were diagnosed in 100 patients; the 5-year cumulative prevalence was 45.2%. An insufficiency fracture was diagnosed a median of 16.9 months after radiation therapy. The fracture sites were the sacrum body and alae, medial side of the iliac bone, the roof of the acetabulum, superior rami of the pubic bone, femoral heads, and L5 vertebra. Sixty-one patients (61%) developed multiple fractures, and among them, 40 (40%) had bilateral symmetric lesions of the sacral alae. Other complications associated with the radiation therapy, as determined by evaluation of the MR images, were osteolysis and avascular necrosis of the femoral head.


CONCLUSIONS
Radiation-induced pelvic insufficiency fractures are a frequent complication of radiation therapy for uterine cervical cancer. Osteolysis and avascular necrosis of the femoral head were also diagnosed using MRI after radiation therapy.
Kwon
Jong Won
JW
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Huh
Seung Jae
SJ
Yoon
Young Cheol
YC
Choi
Sang-Hee
SH
Jung
Jee Young
JY
Oh
Dongryul
D
Choe
Bong Keun
BK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010384:Pelvic Bones / Q000528:radiation effects*; D015995:Prevalence; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*