title: Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT.
abstract: OBJECTIVE
  To determine the incidence, risk factors, and clinical characteristics of pelvic insufficiency fracture (PIF) in patients with cervical cancer.
  
  
  METHODS
  Between July 2004 and August 2009, 235 patients with non-metastatic cervical cancer were treated with definitive chemoradiation or postoperative radiotherapy. Among 235 patients, 117 (49.8%) underwent the first positron emission tomography/computed tomography (PET/CT) within 1 year after radiotherapy. The median radiation dose was 55 Gy (range, 45 to 60 Gy). Medical charts and imaging studies, including PET/CT, magnetic resonance imaging (MRI), CT, bone scintigraphy were reviewed to evaluate the patients with PIF.
  
  
  RESULTS
  Among 235 patients, 16 developed PIF. The 5-year detection rate of PIF was 9.5%. The 5-year detection rate of PIF in patients who underwent the first PET/CT within a year was 15.6%. The median time to development of PIF was 12.5 months (range, 5 to 30 months). The sites of fracture included 12 sacroiliac joints, 3 pubic rami, 3 iliac bones, and 1 femoral neck. Eleven of 16 patients having PIF complained of hip pain requiring medications. One patient required hospitalization for pain control. The significant risk factors of PIF were old age, body mass index less than 23, bone mineral density less than -3.5 SD, and the first PET/CT within a year after radiotherapy. Radiation dose and concurrent chemotherapy had no impact on PIF rate.
  
  
  CONCLUSIONS
  PIFs were not rare after pelvic radiotherapy in cervical cancer patients in the era of PET/CT. Timely diagnosis and management of PIF can improve quality of life in patients with cervical cancer, in addition to reducing unnecessary medical expenses.
authors.affiliation: Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Shin-Hyung
authors.initials: SH
authors.lastname: Park
authors.forename: Jae-Chul
authors.initials: JC
authors.lastname: Kim
authors.forename: Jeong-Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: In-Kyu
authors.initials: IK
authors.lastname: Park