Duranson Agathe, Thevenet Vincent, Guyon Frédéric, Babin Guillaume, Lebreton Coriolan, Renaud Tiphaine, Gaillard Anne-Lise, Dupuy Quentin, Bouleftour Wafa, Magne Nicolas, Petit Adeline
Department of Radiation Oncology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France.
Department of Statistics, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France.
Clin Transl Radiat Oncol. 2023 Jun 12;41:100650. doi: 10.1016/j.ctro.2023.100650. eCollection 2023 Jul.
The aim of this study was to evaluate the incidence and predictive factors of Pelvic Insufficiency Fractures (PIFs) occurring after Intensity Modulated Radiation Therapy (IMRT) combined with chemotherapy for locally advanced cervical cancer (CC).
Medical records of patients receiving radio-chemotherapy with IMRT between 2010 and 2020 for advanced CC were reviewed. PIFs were detected during follow-up on pelvic Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). The cumulative incidence rate of PIFs and its confidence interval were calculated at 2 and 5 years of follow-up. Pre-therapeutic Bone Mineral Density (BMD) (g/cm) was evaluated on CT simulation for sacrum and the fourth lumbar (L4) vertebrae. Sacrum dosimetric parameters (V30Gy, V40Gy, D50%, Dmean) were analyzed.
136 patients were included. The median follow-up was 4.4 years. Median dose of D50% and V40Gy sacrum were 35.2 Gy (20.6-46.4) and 32.2% (7.2-73.4) respectively. The 2-year and 5-year cumulative incidence rates were 15.7% (95% CI: 9.88-22.71) and 22% (95% CI: 14.58-30.45) respectively. Median time interval between RT completion and PIFs' detection was 11.5 months (IQR: 7.4-22.3). Univariate analysis showed that older age (p < 0.01), postmenopausal status at baseline (p < 0.01), and lower sacral and spinal BMD at baseline (respectively p < 0.001 and p < 0.01) were significantly associated to all sites of PIFs, and lower sacral BMD with sacral fractures (p < 0.001).
Post-IMRT PIFs were detected in 18.4% of patients with locally advanced CC. Individual predisposing factors as older age, postmenopausal status, decreased bone density on the CT simulation were mainly predictive.
本研究旨在评估调强放射治疗（IMRT）联合化疗治疗局部晚期宫颈癌（CC）后骨盆不全骨折（PIFs）的发生率及预测因素。
回顾2010年至2020年间接受IMRT同步放化疗的晚期CC患者的病历。在随访期间通过骨盆磁共振成像（MRI）或计算机断层扫描（CT）检测PIFs。计算随访2年和5年时PIFs的累积发病率及其置信区间。在CT模拟中评估骶骨和第四腰椎（L4）椎体的治疗前骨密度（BMD）（g/cm）。分析骶骨剂量学参数（V30Gy、V40Gy、D50%、Dmean）。
纳入136例患者。中位随访时间为4.4年。骶骨的D50%和V40Gy的中位剂量分别为35.2 Gy（20.6 - 46.4）和32.2%（7.2 - 73.4）。2年和5年的累积发病率分别为15.7%（95%CI：9.88 - 22.71）和22%（95%CI：14.58 - 30.45）。放疗结束至PIFs检测的中位时间间隔为11.5个月（IQR：7.4 - 22.3）。单因素分析显示，年龄较大（p < 0.01）、基线时绝经后状态（p < 0.01）以及基线时较低的骶骨和脊柱骨密度（分别为p < 0.001和p < 0.01）与所有部位的PIFs显著相关，较低的骶骨骨密度与骶骨骨折相关（p < 0.001）。
在18.4%的局部晚期CC患者中检测到IMRT后PIFs。年龄较大、绝经后状态、CT模拟时骨密度降低等个体易感因素是主要的预测因素。
