Radiation-Induced Insufficiency Fractures after Pelvic Irradiation for Gynecologic Malignancies: A Systematic Review
Abstract
PURPOSE
To identify and define the incidence, risk factors, clinical characteristics, and treatment approaches to pelvic insufficiency fractures (PIFs) that develop as a consequence of pelvic radiation therapy for gynecologic malignancies.
MATERIALS AND METHODS
A systematic literature review (PubMed and Embase indexed from January 1st, 1980 to May 1st, 2020) of studies describing PIFs that result from radiation therapy for gynecologic malignancies. A random-effects model weighted by the inverse variance was used to calculate the pooled crude incidence, actuarial incidence, proportion of symptomatic PIFs, and to evaluate the relationship between PIF incidence and various risk factors.
RESULTS
Thirty-eight studies describing PIFs following radiation therapy for gynecologic malignancies were reviewed. A meta-analysis of 6,488 patients (37 studies) identified the crude incidence of PIF as 9.4% (95% confidence interval 6.8%-12.4%), while a meta-analysis of 2,131 patients (9 studies) identified the 5-year actuarial incidence of PIF as 15.3% (95% confidence interval 7.5%-25.0%). Factors that significantly correlated with increased risk of PIF development included evidence of osteoporosis (p = <0.001), postmenopausal state (p = <0.001) and history of diabetes mellitus (p = 0.005). Median time to PIF development ranged from 8-39 months following radiation therapy with the sacrum being the most frequent location for fracture development (60%). From 18 studies, 58.5% (95% confidence…
How strong is the evidence?
Evidence Hub reads this as a systematic review. 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: 6,488 participants or records.
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