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Incidence of and Risk Factors for Pelvic Insufficiency Fracture in Patients With Cervical or Endometrial Cancer
Yuanqiong Huang1, Danhong Mao2, Hongbo Chen3
1Department of Oncology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan Province, China.
Purpose:
To investigate the incidence, lesion distribution pattern, and risk factors for pelvic insufficiency fracture (PIF) in cervical and endometrial cancer patients following intensity modulated radiation therapy (IMRT).
Methods And Materials:
In this prospective phase II clinical trial, 113 cervical/endometrial cancer patients who underwent pelvic IMRT at a single hospital (2016-2022) were evaluated. PIF was diagnosed by 2 senior radiologists who were involved in pelvic magnetic resonance imaging, and the results were verified through timely follow-up.
Results:
Following a median of 26 months of follow-up (range, 14-41 months), the incidence of PIF was 29.2%. The median time to PIF was 8.6 months after IMRT (ranging from 3.5 to 13.5 months). Among patients with PIF, the median number of lesions at initial diagnosis was 2 (range, 1-3); 57.6% were symptomatic, and 66.7% had multiple lesions (≥2). The sacrum (33.3%) and ilium (28.2%) were predominantly involved, with a median lesion area of 1.97 cm2 (range, 0.92-3.28 cm2). The median time to peak total PIF lesion area after radiation therapy was 15.8 months (range, 9.7-22.6 months), and the median number of lesions at that time was 4 (range, 3-5). Postmenopausal state (OR, 18.853; 95% CI, 1.396-254.580; P = .027) and a pre-radiation therapy total procollagen type Ⅰ N-terminal propeptide concentration ≥55 ng/mL (OR, 4.743; 95% CI, 1.257-17.915; P = .022) were independent risk factors for PIF. Neither the PIF area (P = .134) nor the number of PIF lesions (P = .157) was related to the severity of pelvic bone pain. No significant association was found between PIF occurrence and pelvic bone dose-volume parameters, clinical factors (age >53 years, treatment type, osteoporosis), or other biochemical markers (all P > .05).
Conclusions:
PIF represents a frequent late complication following pelvic IMRT for cervical and endometrial cancer. It typically manifests as multifocal bone fractures with predominantly mild symptoms, and the total lesion area varies over time. Postmenopausal state and a pre‑IMRT total procollagen type Ⅰ N-terminal propeptide concentration ≥55 ng/mL were independent predictors of PIF occurrence.
