title: Pain and mean absorbed dose to the pubic bone after radiotherapy among gynecological cancer survivors.
abstract: OBJECTIVE
  To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors.
  
  
  METHODS
  In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire.
  
  
  RESULTS
  We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses ≥ 52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence.
  
  
  CONCLUSIONS
  Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. anncharlotte.waldenstrom@oncology.gu.se
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Waldenström
authors.forename: Caroline
authors.initials: C
authors.lastname: Olsson
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.forename: Helena
authors.initials: H
authors.lastname: Lind
authors.forename: Massoud
authors.initials: M
authors.lastname: al-Abany
authors.forename: Åsa
authors.initials: Å
authors.lastname: Palm
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Avall-Lundqvist
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000209:etiology* / Q000503:physiopathology; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D016022:Case-Control Studies; D003131:Combined Modality Therapy / Q000379:methods; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods; D011630:Pubic Bone / Q000000981:diagnostic imaging / Q000528:radiation effects*; D011829:Radiation Dosage; D011859:Radiography; D012893:Sleep Wake Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors; D013548:Sweden; D016138:Walking / Q000502:physiology