Patient selection: woman with cervical cancer receiving curative-intent radiotherapy
Most tumors were squamous (73%), some adenocarcinoma (14%), a few adenosquamous (3%) and the remainder neuroendocrine or other. Most (90%) were Stage I to III.
Most common sites of pelvic fracture: sacrum (96%) with or without pubis (10%) or acetabulum (3.5%)
Frequency: 10% of study group (300 patients)
Risk factors:
(1) older age (median 56.5 years for fracture group vs 46.7 for nonfracture group)
(2) postmenopausal status
(3) lower body mass index (median 26 kg per square meter in fracture group vs 28 in nonfracture group)
An assessment for osteoporosis was not performed prior to radiation therapy.
Fractures tended to appear 1-2 years after radiation therapy with a range from 2 to 63 months. They usually presented with pelvic pain.
The risk for fractures may be reduced by:
(1) osteoporosis screening
(2) therapy to reduce bone resorption
Additional methods to reduce risk might include:
(3) early detection of cervical carcinoma
(4) radiation field planning to distribute radiation exposure