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Sacral Fractures After Short-Course Radiation Therapy for Rectal Cancer.

Panos A Papanikolaou1, I-Chia Liu1, Eric S Christenson2

  • 1Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Advances in Radiation Oncology
|April 20, 2026
PubMed
Summary
This summary is machine-generated.

Sacral fractures are a rare complication after short-course radiation therapy for rectal cancer, occurring in 8.8% of patients within 2 years. Female sex and osteoporosis history increase risk, with most fractures being asymptomatic.

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Area of Science:

  • Oncology
  • Radiology
  • Orthopedics

Background:

  • Sacral fractures are a known complication of pelvic radiation therapy.
  • Their incidence and risk factors after short-course radiation therapy (SCRT) for rectal cancer are not well understood.

Purpose of the Study:

  • To determine the incidence of sacral fractures following SCRT for rectal cancer.
  • To identify patient-level risk factors associated with sacral fracture development.

Main Methods:

  • Retrospective study of 171 rectal adenocarcinoma patients treated with neoadjuvant SCRT and consolidation chemotherapy.
  • Collected demographic, clinical, and treatment data.
  • Calculated fracture incidence and used Cox regression to analyze risk factors.

Main Results:

  • Crude incidence of sacral fracture was 7.6%; 2-year cumulative incidence was 8.8% after a median follow-up of 2.2 years.
  • Female sex (aHR, 6.01) and osteoporosis history (aHR, 7.37) were significant predictors.
  • Most sacral fractures (84.6%) were asymptomatic; other pelvic bone fractures were rare.

Conclusions:

  • The incidence of sacral fractures after SCRT for rectal cancer is low.
  • Female sex and osteoporosis are key risk factors for sacral fracture development.
  • The majority of sacral fractures in this cohort were asymptomatic.