Svanström Röjvall Annika, Buchli Christian, Sääf Maria, Magnusson Per, Flöter Rådestad Angelique, Martling Anna, Segelman Josefin
Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Dept of Surgery, Unit of Gastrointestinal Oncology, Capio S:t Göran's Hospital, Stockholm, Sweden.
Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Dept of Pelvic Cancer, Unit of Gastrointestinal Oncology and Colorectal Surgery, Stockholm, Sweden.
Eur J Surg Oncol. 2022 Dec;48(12):2509-2517. doi: 10.1016/j.ejso.2022.06.028. Epub 2022 Jun 23.
Pelvic radiotherapy (RT) increases the risk of pelvic insufficiency fractures. The aim was to investigate if RT is associated with changes in serum bone biomarkers in women with rectal cancer, and to examine the incidence of radiation-induced bone injuries and the association with bone biomarkers.
Women diagnosed with rectal cancer stage I-III, planned for abdominal surgery ± preoperative (chemo) RT, were prospectively included and followed one year. Serum bone biomarkers comprised sclerostin (regulatory of bone formation), CTX (resorption), BALP and PINP (formation). A subgroup was investigated with annual pelvic magnetic resonance imaging (MRI). The association between RT and bone biomarkers was explored in regression models.
Of 134 included women, 104 had surgery with preoperative RT. The formation markers BALP and PINP increased from baseline to one year in the RT-exposed group (p < 0.001, longitudinal comparison). In the adjusted regression analysis, the mean increase in PINP was higher in the RT-exposed than the unexposed group (17.6 (3.6-31.5) μg/L, p = 0.013). Sclerostin and CTX did not change within groups nor differed between groups. Radiation-induced injuries were detected in 16 (42%) of 38 women with available MRI. At one year, BALP was higher among women with than without bone injuries (p = 0.018, cross-sectional comparison).
Preoperative RT was associated with an increase in the formation marker PINP, which could represent bone recovery following RT-induced injuries, commonly observed in participants evaluated with MRI. These findings should be further explored in larger prospective studies on bone health in rectal cancer patients.
盆腔放疗（RT）会增加盆腔不全骨折的风险。本研究旨在调查放疗是否与直肠癌女性患者血清骨生物标志物的变化有关，并检查放射性骨损伤的发生率及其与骨生物标志物的关系。
前瞻性纳入计划接受腹部手术±术前（化疗）放疗的I-III期直肠癌女性患者，并随访一年。血清骨生物标志物包括骨硬化蛋白（骨形成调节因子）、CTX（骨吸收）、BALP和PINP（骨形成）。对一个亚组进行年度盆腔磁共振成像（MRI）检查。在回归模型中探讨放疗与骨生物标志物之间的关联。
在纳入的134名女性中，104名接受了术前放疗的手术。放疗暴露组中，骨形成标志物BALP和PINP从基线到一年时升高（p<0.001，纵向比较）。在调整后的回归分析中，放疗暴露组PINP的平均升高高于未暴露组（17.6（3.6-31.5）μg/L，p=0.013）。骨硬化蛋白和CTX在组内未发生变化，组间也无差异。在38名有MRI检查结果的女性中，16名（42%）检测到放射性损伤。一年时，有骨损伤的女性的BALP高于无骨损伤的女性（p=0.018，横断面比较）。
术前放疗与骨形成标志物PINP的升高有关，这可能代表放疗引起损伤后的骨恢复，这在接受MRI评估的参与者中很常见。这些发现应在关于直肠癌患者骨健康的更大规模前瞻性研究中进一步探索。
