Grigsby P W, Roberts H L, Perez C A
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Int J Radiat Oncol Biol Phys. 1995 Apr 30;32(1):63-7. doi: 10.1016/0360-3016(95)00546-B.
The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies.
The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis.
The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture.
Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication.
评估妇科恶性肿瘤腹股沟区放疗后股骨颈骨折的发生率及危险因素。
回顾了1954年至1992年在马林克罗特放射研究所接受治疗的1313例阴道、外阴、宫颈和子宫内膜晚期及复发性癌症患者的放疗记录。中位随访时间为12.7年。从该组患者中，确定了207例接受前后位-后前位（AP-PA）18MV光子盆腔及腹股沟区放疗的患者。审查了有关股骨颈照射剂量以及其他假定危险因素的数据，包括年龄、原发部位、分期、腹股沟淋巴结状态、绝经状态、雌激素使用、吸烟、饮酒和骨质疏松症。
股骨颈骨折的患者发生率为4.8%（207例中有10例）。4例患者发生双侧骨折。然而，骨折的累积精算发生率在5年时为11%，在10年时为15%。对年龄、体重和照射剂量进行Cox多因素分析表明，只有照射剂量可能对骨折的发生有重要影响。对假定的预后因素进行逐步逻辑回归分析显示，只有吸烟和放疗前骨质疏松的X线证据可预测骨折。
股骨头骨折是妇科恶性肿瘤腹股沟区放疗的常见并发症。我们数据库中的骨折似乎与照射剂量、吸烟和骨质疏松的X线证据有关。在治疗计划中应特别注意（即股骨头/颈的屏蔽以及部分治疗使用合适的电子束能量）以降低该并发症的发生率。
