宫颈癌调强放疗后骨盆衰竭骨折的发生率及影响因素分析

The incidence and risk factors of pelvic insufficiency fracture in patients with cervical cancer after intensity-modulated radiotherapy

目的探讨宫颈癌盆腔调强放疗后患者骨盆衰竭骨折（PIF）的发生率及影响因素。方法收集2013年11月至2015年12月在本院行盆腔调强放疗的104例宫颈癌患者，回顾性分析随访过程中骨盆衰竭骨折的发生情况及其影响因素。结果104例患者中，16例（31个部位）患者发生了骨盆衰竭骨折，发生率为15．4％；其中多发骨折患者10例（62．5％）。有症状的患者5例（31％），经休息或止痛治疗后症状可缓解。骨折发生的时间是放疗结束后1～16个月（平均6．5个月）。发生的部位分别是骶骨16例（51．6％）、骶髂关节7例（22．6％）、髂骨6例（19．4％）、股骨头1例（3．2％）及耻骨1例（3．2％）。单因素和多因素分析显示，绝经后状态和低体重（≤55kg）是宫颈癌盆腔调强放疗后骨盆衰竭骨折的危险因素（P〈0．05）。亚组分析发现，对宫颈癌术后辅助调强放疗患者，绝经后状态是盆腔调强放疗后衰竭骨折的危险因素（P〈0．05）。结论绝经后状态和低体重（≤55kg）是影响宫颈癌患者盆腔调强放疗后衰竭骨折发生的重要危险因素。

Objective To analyze the incidence and risk factors of pelvic insufficiency fractures （PIF） in patients with cervical cancer who received pelvic intensity-modulated radiotherapy. Methods This study a retrospective review of all patients was performed with cervical cancer who received pelvic intensity-modulated radiotherapy at our institution from November 2013 to December 2015, and the incidence and risk factors of insufficiency fractures were analyzed. Results Among the 104 patients, 16 （ with a total of 31 lesions） were diagnosed with pelvic insufficiency fracture. The occurrence rate of pelvic insufficiency was 15.4%. Ten patients （62.5%） had multiple fractures and five patients （31%） complained of pain. All patients＇ pain was relieved by rest or analgesic drugs. Insufficiency fractures were detected at a median of 6. 5 months （range 1 -16） from radiotherapy completion. The distribution of PIFs was followed： sacral had 16 cases （51.6%） , sacroiliac joint had 7 cases （22. 6% ） , iliac had 6 cases （ 19.4% ） , femoral head had 1 case （3.2%） and pubis had 1 case （3.2%）. Univariate analysis and multiple analysis showed that postmenopausal status and low body weight （ ≤55 kg） were thought to be risk factors for PIF（P 〈 0. 05 ）. Subgroup analysis also confirmed that postmenopausal status was a risk factor for PIF （P 〈 0. 05 ） in postoperative cervical cancer patients after pelvic intensity-modulated radiation therapy. Conclusions Cervical cancer patients with menopausal status and low body weight （ ≤55 kg） are at some risk for the development of PIF after pelvic intensity-modulated radiotherapy.