Pelvic insufficiency fractures after external beam radiotherapy for gynecologic cancers: a meta-analysis and meta-regression of 3,929 patients
Abstract
PURPOSE
To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiotherapy for gynecologic cancers based on post-treatment CT, MRI, PET, or bone scintigraphy.
METHODS
A systematic search of databases (PubMed and EMBASE) was performed (CRDXXXXXXXXXXX). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures.
RESULTS
Twenty-one studies met the inclusion criteria (total 3,929 patients). Five hundred and four patients developed PIF, translating into an overall rate of 14% (95%CI: 10-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95%CI: 52-69%, based on 14 studies). The total number of PIFs was 704 (mean 1.72 PIFs per each patient who develop a PIF, based on 14 studies). More recent series (p=0.0074) and use of intensity-modulated radiotherapy [IMRT] (p=0.0299) were associated with lower fracture rates. The most common fracture sites were: 39.7% sacro-iliac joint; 33.9% body of the sacrum; 13% pubis; 7% lumbar vertebra; 2.8% iliac bone; 2.1% acetabulum; and 1.5% femoral head/neck. The median time to fracture was between 7.1 to 19 months after RT.
CONCLUSIONS
The incidence of PIF after radiotherapy for gynecologic cancers is high (14%)…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,929 participants or records.
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