title: Fractures of thoracic vertebrae in patients with locally advanced non-small cell lung carcinoma treated with intensity modulated radiotherapy.
abstract: OBJECTIVE
  To report on the incidence of vertebral fractures in patients treated with Intensity Modulated Radiotherapy (IMRT) for locally advanced non-small cell lung carcinoma (NSCLC) and to analyse the association with clinical and dosimetric parameters.
  
  
  METHODS
  Between 2007 and 2012, 524 patients treated with ⩾51 Gy were retrospectively analysed for the incidence of vertebral fractures (VF). Clinical parameters were assessed. In addition, a case control study in 50 patients was performed to study the association between the radiotherapy dose and fractured vertebrae.
  
  
  RESULTS
  Three hundred and thirty-six patients were eligible for analyses. Twenty-eight patients (8%) were observed with VF at a median follow up of 12 months. Age was significantly higher in the group with VF (p<0.01). After balancing age, the mean vertebrae dose was most significantly associated with fractures of the vertebrae (p<0.01).
  
  
  CONCLUSIONS
  VF was observed in 8% of the patients with locally advanced NSCLC. RT dose was associated with the occurrence of thoracic vertebral fractures.
authors.affiliation: Dept of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Wilma
authors.initials: W
authors.lastname: Uyterlinde
authors.affiliation: Dept of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Dept of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Jose
authors.initials: J
authors.lastname: Belderbos
authors.affiliation: Dept of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Jan-Jakob
authors.initials: JJ
authors.lastname: Sonke
authors.affiliation: Dept of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lange
authors.affiliation: Dept of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Josien
authors.initials: J
authors.lastname: de Bois
authors.affiliation: Dept of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: van den Heuvel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000532:radiotherapy*; D016103:Spinal Fractures / Q000209:etiology; D013904:Thoracic Vertebrae / Q000293:injuries / Q000528:radiation effects*
keywords: IMRT; NSCLC; Toxicity; Vertebrae