Cheng Weishi, Wu Yijun, Shen Jing, Guan Hui, Zhang Li, Zhen Hongnan, Tao Yinjie, Xia Weibo, Liu Zhikai, Zhang Fuquan
Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Biomark Res. 2025 Mar 18;13(1):46. doi: 10.1186/s40364-025-00754-6.
Bone changes in patients undergoing pelvic radiotherapy remain unclear. This study initially utilized high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess the dynamic changes in bone microarchitecture and volumetric bone mineral density (BMD) in patients with cervical cancer before and after concurrent chemoradiotherapy. This prospective, observational study included patients with squamous carcinoma of the cervix scheduled for concurrent chemoradiotherapy. Patients underwent HR-pQCT, dual-energy X-ray absorptiometry (DXA) and laboratory tests before chemoradiotherapy, and at three and six months post-chemoradiotherapy. DXA, serving as the clinical standard for measuring BMD, was employed alongside HR-pQCT to provide complementary insights into bone micro-changes. The primary endpoint comprised changes in total (Tt.vBMD), trabecular (Tb.vBMD) and cortical (Ct.vBMD) volumetric BMD at the distal radius and tibia between pre-chemoradiotherapy and 6 months post-chemoradiotherapy. A total of 21 patients were enrolled, and one patient chose to withdraw (median age: 54.5 years). Tt.vBMD significantly decreased three months (distal radius: -1.65%, P = 0.008; distal tibia: -2.4%, P < 0.001) and six months (distal radius: -3.03%, P = 0.003; distal tibia: -2.69%, P = 0.002) post-chemoradiotherapy compared to baseline. Similarly, Tb.vBMD and Ct.vBMD demonstrated a significant downward trend post-chemoradiotherapy, with mean percent changes at three months of -0.73% and - 1.59% for the distal radius, and - 1.95% and - 1.50% for the distal tibia, respectively. The trends in BMD changes measured by DXA align with those observed using HR-pQCT. Regarding the laboratory tests, estradiol levels significantly decreased post-chemoradiotherapy, while follicle stimulating hormone and luteinizing hormone levels significantly increased. The results found that concurrent chemoradiotherapy was associated with the changes in bone volume, microstructure and BMD, especially in BMD three months post-chemoradiotherapy. Most of the bone micro-changes had not reverted by six months. This study explored the feasibility of early fracture risk identification post-chemoradiotherapy, aiding physicians in taking timely measures to improve prognosis.
接受盆腔放疗患者的骨质变化仍不明确。本研究最初利用高分辨率外周定量计算机断层扫描（HR-pQCT）评估宫颈癌患者同步放化疗前后骨微结构和骨体积密度（BMD）的动态变化。这项前瞻性观察性研究纳入了计划接受同步放化疗的宫颈鳞癌患者。患者在放化疗前、放化疗后3个月和6个月接受HR-pQCT、双能X线吸收法（DXA）检查及实验室检测。DXA作为测量BMD的临床标准，与HR-pQCT一起用于提供关于骨微变化的补充见解。主要终点包括放化疗前至放化疗后6个月桡骨远端和胫骨的总体积骨密度（Tt.vBMD）、小梁骨体积密度（Tb.vBMD）和皮质骨体积密度（Ct.vBMD）的变化。共纳入21例患者，1例患者选择退出（中位年龄：54.5岁）。与基线相比，放化疗后3个月（桡骨远端：-1.65%，P = 0.008；胫骨远端：-2.4%，P < 0.001）和6个月（桡骨远端：-3.03%，P = 0.003；胫骨远端：-2.69%，P = 0.002）时Tt.vBMD显著降低。同样，放化疗后Tb.vBMD和Ct.vBMD也呈显著下降趋势，桡骨远端3个月时的平均变化百分比分别为-0.73%和-1.59%，胫骨远端分别为-1.95%和-1.50%。DXA测量的BMD变化趋势与HR-pQCT观察到的一致。关于实验室检测，放化疗后雌二醇水平显著降低，而促卵泡生成素和促黄体生成素水平显著升高。结果发现，同步放化疗与骨体积、微结构和BMD的变化有关，尤其是放化疗后3个月时的BMD变化。大多数骨微变化在6个月时仍未恢复。本研究探讨了放化疗后早期骨折风险识别的可行性，有助于医生及时采取措施改善预后。
