TY - JOUR
T1 - Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer
T2 - A prospective study of 239 women
AU - Salcedo, Mila P.
AU - Sood, Anil K.
AU - Jhingran, Anuja
AU - Eifel, Patricia J.
AU - Klopp, Ann H.
AU - Iyer, Revathy B.
AU - Fellman, Bryan M.
AU - Jimenez, Camilo
AU - Schmeler, Kathleen M.
N1 - Publisher Copyright:
© 2020 American Cancer Society
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Background: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. Methods: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. Results: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P <.001), higher baseline bone-specific alkaline phosphatase (P <.001), and older age (P =.007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. Conclusions: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.
AB - Background: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. Methods: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. Results: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P <.001), higher baseline bone-specific alkaline phosphatase (P <.001), and older age (P =.007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. Conclusions: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.
KW - bone mineral density
KW - cervical cancer
KW - endometrial cancer
KW - pelvic fractures
KW - radiotherapy
KW - survivorship
KW - vaginal cancer
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U2 - 10.1002/cncr.32807
DO - 10.1002/cncr.32807
M3 - Article
C2 - 32125711
AN - SCOPUS:85080974016
SN - 0008-543X
VL - 126
SP - 2607
EP - 2613
JO - Cancer
JF - Cancer
IS - 11
ER -