Pelvic insufficiency fractures and pelvic bone metastases after neoadjuvant (chemo)radiotherapy for rectal cancer

Authors

  • Lotte Rijpma-Jacobs a Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
  • Ellen van der Vlies b Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands
  • David B. Meek c Department of Radiology, Treant Health Care Group, Hoogeveen, The Netherlands
  • Thomas L. Bollen d Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
  • Peter D. Siersema e Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center, Rotterdam, the Netherlands
  • Bas L. A. M. Weusten f Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands; g Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
  • Martijn Intven h Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
  • Niels van Lelyveld f Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
  • Maartje Los b Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands

DOI:

https://doi.org/10.1080/0284186X.2023.2252168

Keywords:

Rectal cancer, pelvic insufficiency fractures, pelvic bone metastases, radiotherapy, chemoradiotherapy

Abstract

Background

Pelvic insufficiency fractures (PIFs) are a late complication of radiotherapy for pelvic malignancies. We evaluated the incidence, radiologic findings, clinical course, and outcome of PIFs in patients treated with neoadjuvant (chemo)radiotherapy ((C)RT) for rectal cancer.

Material and methods

Data of patients diagnosed with rectal cancer from a large teaching hospital treated from 2002 to 2012 were extracted from the Dutch Cancer Registry. All hospital records were reviewed for the diagnosis of PIFs or pelvic bone metastases. An expert radiologist reassessed all imaging procedures of the lower back, abdomen, and pelvis.

Results

A total of 513 rectal cancer patients were identified of whom 300 patients (58.5%) were treated with neoadjuvant (C)RT (long- vs. short-course radiotherapy: 91 patients [17.7%] vs. 209 [40.7%], respectively). Twelve PIFs were diagnosed initially according to hospital records and imaging reports of all 513 patients. These 12 patients were treated with neoadjuvant (C)RT. After reassessment of all pelvic imaging procedures done in this patient group (432 patients (84.2%)), 20 additional PIFs were detected in patients treated with neoadjuvant (C)RT, resulting in a 10.7% PIF rate in irradiated patients. One PIF was detected in the group of patients not treated with neoadjuvant (C)RT for rectal cancer. This patient had palliative radiotherapy for prostate cancer and is left out of the analysis. Median follow-up time of 32 PIF patients was 49 months. Median time between start of neoadjuvant (C)RT and diagnosis of PIF was 17 months (IQR 9–28). Overall median survival for patients with PIF was 63.5 months (IQR 44–120).

Conclusion

PIFs are a relatively common late complication of neoadjuvant (C)RT for rectal cancer but are often missed or misdiagnosed as pelvic bone metastases. The differentiation of PIFs from pelvic bone metastases is important because of a different treatment and disease outcome.

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Published

2023-10-03

How to Cite

Rijpma-Jacobs, L., van der Vlies, E., Meek, D. B., Bollen, T. L., Siersema, P. D., Weusten, B. L. A. M., … Los, M. (2023). Pelvic insufficiency fractures and pelvic bone metastases after neoadjuvant (chemo)radiotherapy for rectal cancer. Acta Oncologica, 62(10), 1295–1300. https://doi.org/10.1080/0284186X.2023.2252168

Issue

Vol. 62 No. 10 (2023): Acta Oncologica

Section

Articles