Herman Michael P, Kopetz Scott, Bhosale Priya R, Eng Cathy, Skibber John M, Rodriguez-Bigas Miguel A, Feig Barry W, Chang George J, Delclos Marc E, Krishnan Sunil, Crane Christopher H, Das Prajnan
Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2009 Jul 1;74(3):818-23. doi: 10.1016/j.ijrobp.2008.08.054. Epub 2009 Jan 13.
Sacral insufficiency (SI) fractures can occur as a late side effect of pelvic radiation therapy. Our goal was to determine the incidence, risk factors, and clinical course of SI fractures in patients treated with preoperative chemoradiation for rectal cancer.
Between 1989 and 2004, 562 patients with non-metastatic rectal adenocarcinoma were treated with preoperative chemoradiation followed by mesorectal excision. The median radiotherapy dose was 45 Gy. The hospital records and radiology reports of these patients were reviewed to identify those with pelvic fractures. Radiology images of patients with pelvic fractures were then reviewed to identify those with SI fractures.
Among the 562 patients, 15 had SI fractures. The 3-year actuarial rate of SI fractures was 3.1%. The median time to SI fractures was 17 months (range, 2-34 months). The risk of SI fractures was significantly higher in women compared to men (5.8% vs. 1.6%, p = 0.014), and in whites compared with non-whites (4% vs. 0%, p = 0.037). On multivariate analysis, gender independently predicted for the risk of SI fractures (hazard ratio, 3.25; p = 0.031). Documentation about the presence or absence of pain was available for 13 patients; of these 7 (54%) had symptoms requiring pain medications. The median duration of pain was 22 months. No patient required hospitalization or invasive intervention for pain control.
SI fractures were uncommon in patients treated with preoperative chemoradiation for rectal cancer. The risk of SI fractures was significantly higher in women. Most cases of SI fractures can be managed conservatively with pain medications.
骶骨不全（SI）骨折可能作为盆腔放射治疗的晚期副作用出现。我们的目标是确定接受直肠癌术前放化疗患者中SI骨折的发生率、危险因素及临床病程。
1989年至2004年期间，562例非转移性直肠腺癌患者接受了术前放化疗，随后行直肠系膜切除术。放疗中位剂量为45 Gy。回顾这些患者的医院记录和放射学报告以确定有骨盆骨折的患者。然后对骨盆骨折患者的放射学影像进行复查以确定有SI骨折的患者。
562例患者中，15例发生SI骨折。SI骨折的3年精算发生率为3.1%。发生SI骨折的中位时间为17个月（范围2 - 34个月）。女性发生SI骨折的风险显著高于男性（5.8%对1.6%，p = 0.014），白人高于非白人（4%对0%，p = 0.037）。多因素分析显示，性别独立预测SI骨折风险（风险比，3.25；p = 0.031）。13例患者有关于疼痛存在与否的记录；其中7例（54%）有需要使用止痛药物的症状。疼痛的中位持续时间为22个月。没有患者因疼痛控制需要住院或进行侵入性干预。
直肠癌术前放化疗患者中SI骨折并不常见。女性发生SI骨折的风险显著更高。大多数SI骨折病例可通过止痛药物进行保守治疗。
