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Review
. 2017 May;90(1073):20160885.
doi: 10.1259/bjr.20160885. Epub 2017 Mar 14.

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

Louis Bazire  1 , Haoping Xu  1 , Jean-Philippe Foy  1 , Malika Amessis  1 , Caroline Malhaire  1 , Kim Cao  1 , Anne De La Rochefordiere  1 , Youlia M Kirova  1
Affiliations
Review

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

Louis Bazire et al. Br J Radiol. 2017 May.

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).

Conclusion: 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.

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Figures

Figure 1.
Figure 1.
An MR axial image demonstrating a pelvic insufficiency fracture: turbo spin-echo T2 weighted MR axial image (a) shows hypointense undisplaced fracture of the sacral ala with heterogeneous signal of the bone marrow (white arrows); fat-suppressed T1 weighted contrast-enhanced axial image (B) depicts intense sacral enhancement indicating bone marrow oedema (black arrow) and hypointense fracture line (black arrowhead).
Figure 2.
Figure 2.
Distribution of pelvic insufficiency fracture.
Figure 3.
Figure 3.
Pelvic insufficiency fracture rates by tumour location.
Figure 4.
Figure 4.
Comparison of the maximum dose between patients with fractures and patients who are fracture free.
See this image and copyright information in PMC

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