An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiot
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ORIGINAL ARTICLE
An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiotherapy for cervical cancer Drilon Kurrumeli1,2 · Markus Oechsner1 · Bianca Weidenbächer1 · Christine Brambs3 · Maximilian Löffler4 · Stephanie Elisabeth Combs1,5,6 · Kai Borm1 · Marciana Nona Duma2,7 Received: 23 April 2020 / Accepted: 7 September 2020 © The Author(s) 2020
Abstract Purpose The aim of this study was to investigate whether bone mineral density (BMD) as measured in planning computed tomographies (CTs) by a new method is a risk factor for pelvic insufficiency fractures (PIF) after radio(chemo)therapy (R(C)T) for cervical cancer. Methods 62 patients with cervical cancer who received definitive or adjuvant radio(chemo)therapy between 2013 and 2017 were reviewed. The PIF were detected on follow-up magntic resonance imaging (MRI). The MRI of the PIF patients was registered to the planning CT and the PIF contoured. On the contralateral side of the fracture, a mirrored structure of the fracture was generated (mPIF). For the whole sacral bone, three lumbar vertebrae, the first and second sacral vertebrae, and the PIF, we analyzed the BMD (mg/cm3), V50Gy, Dmean, and Dmax. Results Out of 62 patients, 6 (9.7%) had a fracture. Two out of the 6 patients had a bilateral fracture with only one of them being symptomatic. PIF patients showed a significantly lower BMD in the sacral and the lumbar vertebrae (p < 0.05). The BMD of the contoured PIF, however, when comparing to the mPIF, did not reach significance (p < 0.49). The difference of the V50Gy of the sacrum in the PIF group compared to the other (OTH) patients, i.e. those without PIF, did not reach significance. Conclusion The dose does not seem to have a relevant impact on the incidence of PIF in our patients. One of the predisposing factors for developing PIF after radiotherapy seems to be the low BMD. We presented an easy method to assess the BMD in planning CTs.
Keywords Gynaecological tumors · Radiation therapy · Magnetic resonance imaging · Cisplatinum
Marciana Nona Duma
[email protected] 1
Department of Radiation Oncology, Klinikum rechts der Isar – Technical University of Munich (TUM), Munich, Germany
2
School of Medicine, Klinikum rechts der Isar – Technical University of Munich (TUM), Munich, Germany
3
Department of Gynaecology, Klinikum rechts der Isar – Technical University of Munich (TUM), Munich, Germany
4
Department of Neuroradiology, Klinikum rechts der Isar – Technical University of Munich (TUM), Munich, Germany
5
Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Munich, Germany
6
German Cancer Consortium (DKTK)-Partner Site Munich, Munich, Germany
7
Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
Introduction Definitive or adjuvant radio(chemo)therapy have both become an essential component in the treatment of cervical cancer, especially in locally adva
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