Fractures of the sacrum after chemoradiation for rectal carcinoma: Incidence, risk factors, and radiographic evaluation Journal Article
| Authors: | Kim, H. J.; Boland, P. J.; Meredith, D. S.; Lis, E.; Zhang, Z.; Shi, W.; Yamada, Y. J.; Goodman, K. A. |
| Article Title: | Fractures of the sacrum after chemoradiation for rectal carcinoma: Incidence, risk factors, and radiographic evaluation |
| Abstract: | Purpose: Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients. Methods and Materials: Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision. Of these, 492 patients had imaging studies available for review. Hospital records and imaging studies from all 492 patients were retrospectively evaluated to identify risk factors associated with developing a sacral insufficiency fracture. Results: With a median follow-up time of 3.5 years, the incidence of sacral fractures was 7.1% (35/492). The 4-year sacral fracture free rate was 0.91. Univariate analysis showed that increasing age (≥60 vs. <60 years), female sex, and history of osteoporosis were significantly associated with shorter time to sacral fracture (P=.01, P=.004, P=.001, respectively). There was no significant difference in the time to sacral fracture for patients based on stage, radiotherapy dose, or chemotherapy regimen. Multivariate analysis showed increasing age (≥60 vs. <60 years, hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.22-5.13, P=.01), female sex (HR = 2.64, CI = 1.29-5.38, P=.008), and history of osteoporosis (HR = 3.23, CI = 1.23-8.50, P=.02) were independent risk factors associated with sacral fracture. Conclusions: Sacral insufficiency fractures after pelvic radiation for rectal carcinoma occur more commonly than previously described. Independent risk factors associated with fracture were osteoporosis, female sex, and age greater than 60 years. © 2012 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; middle aged; cancer surgery; fracture; retrospective studies; major clinical study; disease course; fluorouracil; advanced cancer; radiation dose; chemotherapy; follow up; demography; disease association; pain; clinical assessment; incidence; risk factors; retrospective study; risk factor; irinotecan; confidence interval; conservative treatment; folinic acid; sex difference; hazard ratio; age distribution; osteoporosis; surgical excision; oxaliplatin; rectum carcinoma; multi variate analysis; univariate analysis; analysis of variance; rectal neoplasms; chemoradiation; sacrum; diseases; chemoradiotherapy; spinal fractures; adjuvant radiation; clinical assessments; pelvic radiation; pelvis fracture; sacral insufficiency fracture; chemoradiotherapy, adjuvant |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 84 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-11-01 |
| Start Page: | 694 |
| End Page: | 699 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2012.01.021 |
| PROVIDER: | scopus |
| PUBMED: | 22867889 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 2 November 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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