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Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer: A prospective study of 239 women.

Authors :
Salcedo MP
Sood AK
Jhingran A
Eifel PJ
Klopp AH
Iyer RB
Fellman BM
Jimenez C
Schmeler KM
Source :
Cancer [Cancer] 2020 Jun 01; Vol. 126 (11), pp. 2607-2613. Date of Electronic Publication: 2020 Mar 03.
Publication Year :
2020

Abstract

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.<br />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.<br />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.<br />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.<br /> (© 2020 American Cancer Society.)

Details

Language :
English
ISSN :
1097-0142
Volume :
126
Issue :
11
Database :
MEDLINE
Journal :
Cancer
Publication Type :
Academic Journal
Accession number :
32125711
Full Text :
https://doi.org/10.1002/cncr.32807