Risk Factors for Sacral Insufficiency Fractures in Cervical Cancer After Whole Pelvic Radiation Therapy

Aim: To evaluate the incidence and risk factors of sacral insufficiency fractures (SIFs), particularly dose–volume histogram (DVH) parameters, in patients with cervical cancer after whole pelvic radiation therapy (WPRT). Patients and Methods: The medical records of 61 patients with cervical cancer who underwent WPRT were retrospectively reviewed. The cumulative incidence of SIF, as well as the risk factors that could affect its incidence were assessed. Results: Of the 61 patients, 11 (18%) were diagnosed with SIF, as revealed by computed tomography. Multivariate analysis revealed that abnormal body mass index (BMI) (more than 25 kg/m² or below 18 kg/m²) and administration of five or more chemotherapy cycles were independently associated with SIF. A slight difference was observed in the D50% (the administered dose covering half of the sacrum) between patients with and those without SIF (p=0.052). Conclusion: Thus, the D50% of the sacrum should be particularly considered in patients with abnormal BMI and five or more cycles of chemotherapy.

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