BACKGROUND Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. METHODS Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. RESULTS The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P < .001), higher baseline bone-specific alkaline phosphatase (P < .001), and older age (P = .007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. CONCLUSIONS A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.

中文翻译：

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宫颈癌、子宫内膜癌和阴道癌放疗后骨盆骨折和骨密度变化：一项对 239 名女性的前瞻性研究。

背景 放疗 (RT) 的进步已经改善了患有妇科癌症的女性的肿瘤结果；然而，长期影响和生存影响需要进一步评估。本研究的目的是确定骨盆放疗后骨盆骨折的发生率和骨矿物质密度 (BMD) 的变化。方法 前瞻性研究了 239 名在 2008 年至 2015 年期间因宫颈癌、子宫内膜癌或阴道癌接受盆腔放疗的女性。在基线和放疗后 3 个月、1 年和 2 年获得 BMD 扫描和骨转换生物标志物。对骨盆骨折的影像学研究进行了长达 5 年的评估。任何时候出现骨质减少、骨质疏松或骨盆骨折的患者都被转诊到内分泌科进行评估和治疗。结果 诊断时的中位年龄为 51 岁；132 名患者 (56%) 已绝经。主要诊断为宫颈癌 (63.6%)、子宫内膜癌 (30.5%) 和阴道癌 (5.9%)。16 名患者（7.8%；95% 置信区间，4.5%-12.4%）发生骨盆骨折，1、2 和 3 年的精算率分别为 3.6%、12.7% 和 15.7%。骨折与基线骨质疏松症 (P < .001)、较高的基线骨特异性碱性磷酸酶 (P < .001) 和年龄较大 (P = .007) 相关。骨质减少/骨质疏松患者的比例从基线时的 50% 分别增加到 3 个月、1 年和 2 年时的 58%、59% 和 70%。结论 骨盆放疗后，高比例的女性 BMD 显着降低，7.8% 的女性被诊断为骨盆骨折。