Radiation Oncology Journal

  • 제32권4호
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  • Pages.213-220
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  • 2014
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  • 2234-1900(pISSN)
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  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
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Insufficiency fracture after radiation therapy

  • Oh, Dongryul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2014.11.28
  • 심사 : 2014.12.09
  • 발행 : 2014.12.31
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초록

Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

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참고문헌

  1. Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathologic fractures. JAMA 1964;187:1001-4.
  2. Cooper KL, Beabout JW, Swee RG. Insufficiency fractures of the sacrum. Radiology 1985;156:15-20. https://doi.org/10.1148/radiology.156.1.4001403
  3. Peh WC, Gough AK, Sheeran T, Evans NS, Emery P. Pelvic insufficiency fractures in rheumatoid arthritis. Br J Rheumatol 1993;32:319-24. https://doi.org/10.1093/rheumatology/32.4.319
  4. Finiels H, Finiels PJ, Jacquot JM, Strubel D. Fractures of the sacrum caused by bone insufficiency, meta-analysis of 508 cases. Presse Med 1997;26:1568-73.
  5. Ikushima H, Osaki K, Furutani S, et al. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol 2006;103:1100-4. https://doi.org/10.1016/j.ygyno.2006.06.038
  6. Ogino I, Okamoto N, Ono Y, Kitamura T, Nakayama H. Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy. Radiother Oncol 2003;68:61-7. https://doi.org/10.1016/S0167-8140(03)00128-2
  7. Park SH, Kim JC, Lee JE, Park IK. Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT. Radiat Oncol J 2011;29:269-76. https://doi.org/10.3857/roj.2011.29.4.269
  8. Oh D, Huh SJ, Nam H, et al. Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: analysis of risk factors. Int J Radiat Oncol Biol Phys 2008;70:1183-8. https://doi.org/10.1016/j.ijrobp.2007.08.005
  9. Uezono H, Tsujino K, Moriki K, et al. Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors. J Radiat Res 2013;54:1102-9. https://doi.org/10.1093/jrr/rrt055
  10. Kwon JW, Huh SJ, Yoon YC, et al. Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI. AJR Am J Roentgenol 2008;191:987-94. https://doi.org/10.2214/AJR.07.3634
  11. Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA 2005;294:2587-93. https://doi.org/10.1001/jama.294.20.2587
  12. Tokumaru S, Toita T, Oguchi M, et al. Insufficiency fractures after pelvic radiation therapy for uterine cervical cancer: an analysis of subjects in a prospective multi-institutional trial, and cooperative study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG). Int J Radiat Oncol Biol Phys 2012;84:e195-200. https://doi.org/10.1016/j.ijrobp.2012.03.042
  13. Igdem S, Alco G, Ercan T, et al. Insufficiency fractures after pelvic radiotherapy in patients with prostate cancer. Int J Radiat Oncol Biol Phys 2010;77:818-23. https://doi.org/10.1016/j.ijrobp.2009.05.059
  14. Kim HJ, Boland PJ, Meredith DS, et al. Fractures of the sacrum after chemoradiation for rectal carcinoma: incidence, risk factors, and radiographic evaluation. Int J Radiat Oncol Biol Phys 2012;84:694-9. https://doi.org/10.1016/j.ijrobp.2012.01.021
  15. Herman MP, Kopetz S, Bhosale PR, et al. Sacral insufficiency fractures after preoperative chemoradiation for rectal cancer: incidence, risk factors, and clinical course. Int J Radiat Oncol Biol Phys 2009;74:818-23. https://doi.org/10.1016/j.ijrobp.2008.08.054
  16. Blomlie V, Rofstad EK, Talle K, Sundfor K, Winderen M, Lien HH. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR Am J Roentgenol 1996;167:1205-10. https://doi.org/10.2214/ajr.167.5.8911181
  17. Abe H, Nakamura M, Takahashi S, Maruoka S, Ogawa Y, Sakamoto K. Radiation-induced insufficiency fractures of the pelvis: evaluation with 99mTc-methylene diphosphonate scintigraphy. AJR Am J Roentgenol 1992;158:599-602. https://doi.org/10.2214/ajr.158.3.1739002
  18. Peh WC, Khong PL, Yin Y, et al. Imaging of pelvic insufficiency fractures. Radiographics 1996;16:335-48. https://doi.org/10.1148/radiographics.16.2.8966291
  19. Lin J, Lachmann E, Nagler W. Sacral insufficiency fractures: a report of two cases and a review of the literature. J Womens Health Gend Based Med 2001;10:699-705. https://doi.org/10.1089/15246090152563588
  20. De Smet AA, Neff JR. Pubic and sacral insufficiency fractures: clinical course and radiologic findings. AJR Am J Roentgenol 1985;145:601-6. https://doi.org/10.2214/ajr.145.3.601
  21. Epps HR, Brinker MR, O'Connor DP. Bilateral femoral neck fractures after pelvic irradiation. Am J Orthop (Belle Mead NJ) 2004;33:457-60.
  22. McKean H, Miller RC, Jatoi A. Non-traumatic vertebral fractures in patients with locally advanced esophageal cancer: a previously unreported, unrecognized problem. Dis Esophagus 2007;20:102-6. https://doi.org/10.1111/j.1442-2050.2007.00645.x
  23. Howland WJ, Loeffler RK, Starchman DE, Johnson RG. Postirradiation atrophic changes of bone and related complications. Radiology 1975;117(3 Pt 1):677-85. https://doi.org/10.1148/117.3.677
  24. Hopewell JW. Radiation-therapy effects on bone density. Med Pediatr Oncol 2003;41:208-11. https://doi.org/10.1002/mpo.10338
  25. Williams HJ, Davies AM. The effect of X-rays on bone: a pictorial review. Eur Radiol 2006;16:619-33. https://doi.org/10.1007/s00330-005-0010-7
  26. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109-22.
  27. Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med 1998;338:736-46. https://doi.org/10.1056/NEJM199803123381107
  28. Fu AL, Greven KM, Maruyama Y. Radiation osteitis and insufficiency fractures after pelvic irradiation for gynecologic malignancies. Am J Clin Oncol 1994;17:248-54. https://doi.org/10.1097/00000421-199406000-00015
  29. Jenkins PJ, Montefiore DJ, Arnott SJ. Hip complications following chemoradiotherapy. Clin Oncol (R Coll Radiol) 1995;7:123-6. https://doi.org/10.1016/S0936-6555(05)80815-5
  30. Newhouse KE, el-Khoury GY, Buckwalter JA. Occult sacral fractures in osteopenic patients. J Bone Joint Surg Am 1992;74:1472-7.
  31. Mammone JF, Schweitzer ME. MRI of occult sacral insufficiency fractures following radiotherapy. Skeletal Radiol 1995;24:101-4.
  32. Stevens SK, Moore SG, Kaplan ID. Early and late bone- marrow changes after irradiation: MR evaluation. AJR Am J Roentgenol 1990;154:745-50. https://doi.org/10.2214/ajr.154.4.2107669
  33. Fayad LM, Cohade C, Wahl RL, Fishman EK. Sacral fractures: a potential pitfall of FDG positron emission tomography. AJR Am J Roentgenol 2003;181:1239-43. https://doi.org/10.2214/ajr.181.5.1811239
  34. Ravenel JG, Gordon LL, Pope TL, Reed CE. FDG-PET uptake in occult acute pelvic fracture. Skeletal Radiol 2004;33:99-101. https://doi.org/10.1007/s00256-003-0711-4
  35. Tsuchida T, Kosaka N, Sugimoto K, Itoh H. Sacral insufficiency fracture detected by FDG-PET/CT: report of 2 cases. Ann Nucl Med 2006;20:445-8. https://doi.org/10.1007/BF03027382
  36. Oh D, Huh SJ, Lee SJ, Kwon JW. Variation in FDG uptake on PET in patients with radiation-induced pelvic insufficiency fractures: a review of 10 cases. Ann Nucl Med 2009;23:511-6. https://doi.org/10.1007/s12149-009-0267-z
  37. Kato K, Aoki J, Endo K. Utility of FDG-PET in differential diagnosis of benign and malignant fractures in acute to subacute phase. Ann Nucl Med 2003;17:41-6. https://doi.org/10.1007/BF02988257
  38. Casey D, Mirra J, Staple TW. Parasymphyseal insufficiency fractures of the os pubis. AJR Am J Roentgenol 1984;142:581-6. https://doi.org/10.2214/ajr.142.3.581
  39. Hall FM, Goldberg RP, Kasdon EJ, Glick H. Post-traumatic osteolysis of the pubic bone simulating a malignant lesion. J Bone Joint Surg Am 1984;66:121-6. https://doi.org/10.2106/00004623-198466010-00017
  40. Base NS, Ozguroglu M, Kamberoglu K, Karahasanoglu T, Ober A. Pentoxifylline in the treatment of radiation-related pelvic insufficiency fractures of bone. Radiat Med 2003;21:223-7.
  41. Heron J, Connell DA, James SL. CT-guided sacroplasty for the treatment of sacral insufficiency fractures. Clin Radiol 2007;62:1094-103. https://doi.org/10.1016/j.crad.2007.04.017

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  15. Radiation-induced changes to bone composition extend beyond periosteal bone vol.12, pp.None, 2014, https://doi.org/10.1016/j.bonr.2020.100262
  16. The Role of Comprehensive Geriatric Assessment in the Treatment of Cancer Patients of Elderly and Senile Age vol.10, pp.4, 2020, https://doi.org/10.1134/s2079057020040025
  17. Treatment of Radiation-Associated Fractures : A Critical Analysis Review vol.9, pp.8, 2021, https://doi.org/10.2106/jbjs.rvw.20.00275
  18. Strategies to Minimize Late Effects From Pelvic Radiotherapy vol.41, pp.None, 2014, https://doi.org/10.1200/edbk_320999
  19. Relations Between Bone Quantity, Microarchitecture, and Collagen Cross‐links on Mechanics Following In Vivo Irradiation in Mice vol.5, pp.11, 2014, https://doi.org/10.1002/jbm4.10545
  20. Musculoskeletal Applications of Magnetic Resonance-Guided Focused Ultrasound vol.25, pp.6, 2014, https://doi.org/10.1055/s-0041-1735472
  21. Management of late adverse effects after chemoradiation for anal cancer vol.60, pp.12, 2021, https://doi.org/10.1080/0284186x.2021.1983208