title: Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature.
abstract: OBJECTIVE
  To summarize the results of pelvic insufficiency fracture (PIF) incidence in patients with anal or gynaecological cancer treated by pelvic intensity-modulated radiation therapy (IMRT).
  
  
  METHODS
  The clinical and morphological (CT and/or pelvic MRI) characteristics of patients treated by IMRT at our institution between 2007 and 2014 were analyzed. The global incidence of PIF after external beam radiotherapy and the impact of tumour site (gynaecological or anal cancer) were determined. A dosimetric study was then performed to compare patients with and without pelvic fracture.
  
  
  RESULTS
  341 patients were treated by IMRT for gynaecological or anal cancer between 2007 and 2014. 15 patients experienced at least 1 pelvic fracture after external beam radiotherapy, corresponding to an overall incidence of 4.4%. Age and menopausal status were correlated with an increased fracture risk (p = 0.0274 and p < 0.0001, respectively). The site of the primary tumour (gynaecological or anal canal) was not associated with an excess fracture risk. The median maximum dose received at the fracture site was 50.3 Gy (range: 40.8-68.4 Gy).
  
  
  CONCLUSIONS
  The incidence of pelvic fracture after IMRT is low, but is higher after the age of 50 and in patients who are postmenopausal. Pre-treatment evaluation of bone density by bone densitometry and phosphorus-calcium assessment could be useful prior to the management of these patients. Advances in knowledge: Pelvic fractures are a frequent complication after radiotherapy. The influence of IMRT and clinical characteristics were evaluated in this study.
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bazire
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Haoping
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Foy
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Malika
authors.initials: M
authors.lastname: Amessis
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Malhaire
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Kim
authors.initials: K
authors.lastname: Cao
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: De La Rochefordiere
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris, France.
authors.forename: Youlia M
authors.initials: YM
authors.lastname: Kirova
mesh_terms: D001005:Anus Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D015775:Fractures, Stress / Q000150:complications* / Q000000981:diagnostic imaging; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed