Pelvic fractures after radiotherapy for cervical cancer: Implications for survivors

BACKGROUND: The incidence of pelvic fractures and associated risk factors was determined in women treated with curative-intent radiotherapy for cervical cancer. METHODS: The records of 516 women treated with curative-intent radiotherapy for cervical cancer between 2001 and 2006 at the University of Texas M. D. Anderson Cancer Center were reviewed. Among these, 300 patients had at least 1 post-treatment computed tomography scan or magnetic resonance imaging study available for review, and they comprised our study population. All imaging studies were rereviewed by a single radiologist to evaluate for fractures. RESULTS: Pelvic fractures were noted in 29 of 300 patients (9.7%). Fracture sites included sacrum (n=24; 83%), sacrum and pubis (n=3; 10%), iliac crest (n=1; 3%), and sacrum and acetabulum (n=1; 3%). Thirteen patients (45%) were symptomatic, with pain being the most common presenting symptom. The median time from the completion of radiotherapy to the detection of fractures on imaging studies was 14.1 months (range, 2.1-63.1 months), with 38% of patients diagnosed within 1 year and 83% diagnosed within 2 years of completing therapy. The median age of the patients at diagnosis was higher in the women who developed a fracture compared with the women who did not (56.5 years vs 46.7 years; P=.04). A higher number of women with a fracture were postmenopausal (62% vs 37%; P=.03). The median body mass index was lower in the women who had a fracture (26.0 kg/m² vs 28.0 kg/m²; P=.03). CONCLUSIONS: Pelvic fractures were detected in a substantial proportion of women after radiotherapy for cervical cancer. Bone mineral density screening and pharmacologic intervention should be considered in these women.