Pelvic insufficiency fractures in patients with pelvic irradiation

被引:61
作者
Moreno, A
Clemente, J
Crespo, C
Martínez, A
Navarro, M
Fernández, L
Minguell, J
Vázquez, G
Andreu, FJ
机构
[1] Hosp Univ San Juan, Serv Oncol Radioterapica, Dept Radiat Oncol, Alicante 03550, Spain
[2] Univ Hosp San Juan, Dept Radiol, Alicante, Spain
[3] Univ Hosp San Juan, Dept Nucl Med, Alicante, Spain
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 1999年 / 44卷 / 01期
关键词
external beam radiotherapy; pelvic insufficiency fractures; pelvic irradiation;
D O I
10.1016/S0360-3016(98)00534-3
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Insufficiency fractures (IF) occur as a result of normal physiological stress on bones with deficient elastic resistance. Pelvic insufficiency fractures are a complication of osteoporosis due to postmenopausal status, high dose of corticosteroids, or local irradiation. They are important because differential diagnosis includes pelvic bone metastases. Diagnosis is based on both clinical manifestations and radiographic and scintigraphic findings. Methods and Materials: We examined eight patients with pelvic cancer who had previously undergone external beam radiation therapy as part of their treatment. In the follow-up, they developed insufficiency fractures, and no factor other than pelvic irradiation was present. Diagnosis was confirmed by radionuclide bone scan followed by conventional radiography and computed tomography (CT) scan. Results: The average onset of symptoms was 13.7 months after radiation therapy was completed. The initial symptom in all cases was pain. In all of the patients, the bone scan showed abnormalities. One to four increased uptake foci were observed, in the sacroiliac joint in all cases, and in the pubis in three cases. The initial diagnosis was bone metastases in five patients. CT scan showed fractures in all of the patients, in sacrum and pubis, both endostic and cortical. Treatment, consisting of nonsteroidal anti-infammatory drugs and rest, led to symptomatic relief in all cases. Conclusion: Knowledge of pelvic insufficiency fractures is essential in order to rule out metastasic disease, and thus avoid inaccurate treatment. Although radionuclide bone scan is useful in early detection of pelvic IF, definitive diagnosis is provided by CT scan. (C) 1999 Elsevier Science Inc.
引用
收藏
页码:61 / 66
页数:6
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