Department of Internal Medicine, Michigan State University College of Human Medicine, Ascension Providence Hospital, Southfield, Michigan.
Department of Obstetrics and Gynecology, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil.
Int J Radiat Oncol Biol Phys. 2020 Mar 1;106(3):475-484. doi: 10.1016/j.ijrobp.2019.09.012. Epub 2019 Sep 30.
To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy.
A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures.
Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy.
The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.
根据妇科癌症外照射治疗后的计算机断层扫描、磁共振成像、正电子发射断层扫描或骨闪烁扫描结果，估计骨盆失能性骨折（PIF）的总体发生率、症状比例和最常见部位。
对数据库（PubMed 和 EMBASE）进行了系统检索（CRD42019125679）。采用随机效应模型，根据方差倒数加权计算总体 PIF 及症状病例比例的汇总摘要。进行多元荟萃回归分析，以评估与 PIF 骨折相关的潜在异质性来源。
21 项研究符合纳入标准（共 3929 例患者）。504 例患者发生 PIF，总体发生率为 14%（95%置信区间，10%-18%，基于 21 项研究）。在这些发生 PIF 的病例中，有症状患者的比例为 61%（95%置信区间，52%-69%，基于 14 项研究）。PIF 总数为 704 例（平均每位发生 PIF 的患者有 1.72 例 PIF，基于 14 项研究）。较新的系列（P =.0074）和使用调强放疗（P =.0299）与较低的骨折率相关。最常见的骨折部位是骶髂关节（39.7%）、骶骨体（33.9%）、耻骨（13%）、腰椎（7%）、髂骨（2.8%）、髋臼（2.1%）和股骨头/颈（1.5%）。骨折发生的中位时间为放疗后 7.1 至 19 个月。
妇科癌症放疗后 PIF 的发生率较高（14%），大多数影响骶骨或骶髂关节（73.6%），但调强放疗似乎可降低这种风险。鉴于近 40%的患者在诊断为 PIF 时无症状，因此该人群需要进行治疗后骨监测。
