title: Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer.
abstract: Insufficiency fractures are recognised consequences of radiotherapy in gynaecological malignancy with reported incidences between 2.7% and 89%. We aimed to determine the incidence and risk factors for insufficiency fractures in patients receiving radical pelvic radiotherapy for uterine and cervical cancer. A case-note review was undertaken of patients treated between January 2007 and December 2008. Insufficiency fractures were identified from radiographs, computed tomography and magnetic resonance images. Chi-squared and Mann-Whitney tests were performed to determine associations between insufficiency fractures and chemotherapy, steroids and age. A total of 285 patients received pelvic radiotherapy, 137 with uterine and 148 with cervical cancer. Mean age was 59 years. A total of 144 patients received chemotherapy, 101 concurrently and 35 adjuvantly. Bone abnormalities affected 67 patients, 33 had pelvic insufficiency fractures, 12 had multiple fractures and 3 patients developed femoral head avascular necrosis. Use of chemotherapy was not associated with development of fractures (P = 0.949). However, cervical cancer patients had a significantly higher incidence of insufficiency fractures (P = 0.018) and bone pain (P = 0.03) compared with uterine cancer patients. This suggests concurrent chemotherapy may be a significant factor in increasing insufficiency fractures and bone morbidity in these patients and highlights a need for further research to identify, prevent and reduce these long-term complications.
authors.affiliation: Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Q
authors.initials: Q
authors.lastname: Mehmood
authors.forename: M
authors.initials: M
authors.lastname: Beardwood
authors.forename: R
authors.initials: R
authors.lastname: Swindell
authors.forename: S
authors.initials: S
authors.lastname: Greenhalgh
authors.forename: T
authors.initials: T
authors.lastname: Wareham
authors.forename: L
authors.initials: L
authors.lastname: Barraclough
authors.forename: J
authors.initials: J
authors.lastname: Livsey
authors.forename: S E
authors.initials: SE
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010384:Pelvic Bones / Q000187:drug effects / Q000293:injuries* / Q000528:radiation effects; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: cervical cancer; chemotherapy; radiotherapy; symptoms