Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Mar-Apr;35(2):1109-1115.
doi: 10.21873/invivo.12356.

Pelvic Insufficiency Fractures in Cervical Cancer After Radiation Therapy: A Meta-Analysis and Review

Youn Kyung Chung #  1 , Young-Kyun Lee #  2 , Byung-Ho Yoon  3 , Dong Hoon Suh  4 , Kyung-Hoi Koo  2   5
Affiliations
Meta-Analysis

Pelvic Insufficiency Fractures in Cervical Cancer After Radiation Therapy: A Meta-Analysis and Review

Youn Kyung Chung et al. In Vivo. 2021 Mar-Apr.

Abstract

Aim: The aim of the study was to estimate the prevalence of pelvic insufficiency fractures (PIFs) after radiation therapy (RT) in patients with cervical cancer.

Patients and methods: A total of 3,633 patients from 15 cohort studies were included. Proportion meta-analysis was performed to estimate prevalence and subgroup analysis was performed according to imaging modalities for diagnosis of PIF. For continuous variables (age and length of follow-up), meta-regression analysis was performed.

Results: Pooled prevalence estimate of PIF was 14% (95% CI=10-19). Incidence of PIF was higher in studies that used MRI as a diagnostic tool (17%, 95% CI=12-22) than non-MRI (8%, 95% CI=2-14). In meta-regression, we found a significant association of prevalence of PIF with age (p=0.021) but not with length of follow-up (p=0.118).

Conclusion: PIF after RT in patients with cervical cancer is not rare. Physicians need to pay attention to PIFs, especially in patients with high-risk factors for osteoporotic fracture.

Keywords: Cervical cancer; insufficiency fracture; osteoporosis; survivoral care.

PubMed Disclaimer

Conflict of interest statement

The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flow diagram detailing the process of relevant clinical study selection.
Figure 2
Figure 2. Forest plots show correlated proportions. (A) The prevalence of pelvic insufficiency fracture in studies used MRI for the diagnosis. (B) The prevalence of pelvic insufficiency fracture in studies did not use MRI for the diagnosis.
Figure 3
Figure 3. Meta-regression plot between the prevalence of pelvic insufficiency fracture and continuous variables from each study. (A) The median patient age of the study. (B) the median length of follow-up. ES, Effect size; FU, follow-up.
Figure 4
Figure 4. Begg’s funnel plot and p-value by Egger’s test. ES, Effect size; se, standard error.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cancer fact sheets: Cervix uteri. Geneva, World Health Organization: Internationanl Agency for Research on Cancer. 2020. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-s... [Last accessed on 1st January 2021]
    1. Klaitong C, Meannuch E, Kaewbunperm U, Klaiphibule P, Sinthusek T. Radiotherapy at pelvis region in menopausal cervix cancer induce osteopenia/osteoporosis. Radiother Oncol. 2018;127:S819–S820. doi: 10.1016/S0167-8140(18)31821-8. - DOI
    1. Wu SG, Zhang WW, He ZY, Sun JY, Wang Y, Zhou J. Comparison of survival outcomes between radical hysterectomy and definitive radiochemotherapy in stage ib1 and iia1 cervical cancer. Cancer Manag Res. 2017;9:813–819. doi: 10.2147/CMAR.S145926. - DOI - PMC - PubMed
    1. Small W Jr, Kachnic L. Postradiotherapy pelvic fractures: Cause for concern or opportunity for future research. JAMA. 2005;294(20):2635–2637. doi: 10.1001/jama.294.20.2635. - DOI - PubMed
    1. Weidenbächer B, Borm KJ, Oechsner M, Schiller K, Kampfer S, Alexander F, Combs SE, Duma MN. Pelvic fractures after radiotherapy for cervical cancer. Strahlenther Onkol. 2018;194(Suppl 1):134. doi: 10.1007/s00066-018-1301-7. - DOI - PubMed

Publication types