title: Relative importance of hip and sacral pain among long-term gynecological cancer survivors treated with pelvic radiotherapy and their relationships to mean absorbed doses.
abstract: OBJECTIVE
  To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs.
  
  
  METHODS
  We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors.
  
  
  RESULTS
  Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy.
  
  
  CONCLUSIONS
  Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. ann-charlotte.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: Eleftheria
authors.initials: E
authors.lastname: Alevronta
authors.forename: Massoud
authors.initials: M
authors.lastname: al-Abany
authors.forename: Susan
authors.initials: S
authors.lastname: Tucker
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Åvall-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; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006615:Hip / Q000000981:diagnostic imaging / Q000528:radiation effects*; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D010146:Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012447:Sacrum / Q000000981:diagnostic imaging / Q000528:radiation effects*; D011795:Surveys and Questionnaires; D017741:Survivors; D013548:Sweden; D014057:Tomography, X-Ray Computed; D016138:Walking