| Autor: |
Väliaho Vesa, Mäkitalo Jaana, Kohonen Ia, Carpelan Anu, Minn Heikki, Ristamäki Raija, Ålgars Annika, Heervä Eetu |
| Jazyk: |
angličtina |
| Rok vydání: |
2023 |
| Předmět: |
|
| Zdroj: |
Clinical and Translational Radiation Oncology, Vol 42, Iss , Pp 100656- (2023) |
| Druh dokumentu: |
article |
| ISSN: |
2405-6308 |
| DOI: |
10.1016/j.ctro.2023.100656 |
| Popis: |
Introduction: Pelvic insufficiency fractures (PIFs) are adverse events associated with chemoradiotherapy (CRT) administered preoperatively in rectal cancer, with incidences of 0–33.6% reported in the literature. Data on PIFs after 5 × 5 Gy fractionated short-course radiotherapy (SCRT) using highly conformal radiotherapy techniques such as volumetric modulated arc therapy (VMAT) is limited. Methods: The Turku University Hospital colorectal cancer database was searched for patients operated on for stage I–III rectal cancer during the years 2014–2018. The hospital’s routine follow-up includes a 2-year computed tomography (CT) scan, which was systemically re-evaluated to detect PIFs. Only radiotherapy delivered using VMAT and image-guided approaches was included. Baseline demographics, tumor data, and dose-volume data were collected to identify risk factors for PIFs. Results: Median time to CT scan was 24 months. Among the 164 patients analyzed, the 2-year PIF incidence was 22.2% for SCRT (n = 12/54, OR 9.1 (CI95% 1.9–42.9), p = 0.004), 9.1% for CRT (n = 4/44, OR 3.2 (CI95% 0.6–18.3), p = 0.13) and 3.0% (n = 2/66, reference) for those operated on without radiotherapy. The PIF incidence was not explained by differences in dose-volume data in either the SCRT or CRT groups. Fracture risk was higher in women, up to 50% after SCRT. Conclusions: Every fifth patient treated with SCRT and rectal surgery presented with a PIF. Critical bony structures to be avoided during radiotherapy contouring could not be identified. Clinicians, especially those involved with the follow-up of rectal cancer, should be aware of this potentially debilitating and surprisingly common adverse event. |
| Databáze: |
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