Pelvic Insufficiency Fracture after Pelvic Irradiation in Uterine Cervix Cancer

Objectives. Pelvic insufficiency fractures (IF) are well known but uncommon and are frequently misinterpreted sequelae. The clinical features were investigated. Methods. Four hundred sixty-three patients, who were treated between 1994 and 2000 for uterine cervix cancer, were clinically examined. All patients had been treated with 10 or 15 MV photons, with 50.4–55.8 Gy in 28 fractions with adjuvant intent ( n = 235) in addition to high-dose-rate brachytherapy 24 Gy in 6 fractions for curative treatment ( n = 228). The median follow-up was 38 months. Results. Eight patients (8/463, 1.7%) developed pelvic IF 7–19 months (median, 12 months) after the treatment. Among these, seven patients (7/228, 3.1%) were treated with curative intent and one (1/235, 0.4%) was treated with adjuvant intent. All patients were postmenopausal and complained of moderate to severe pelvic pain, which resolved after 1–11 months with conservative therapy in all patients. Two of these patients also had radiation proctitis. Conclusion. In women who present with pelvic pain after radiotherapy for cervical cancer, bony destruction and fractures may be indicative of a late radiation effect rather than osseous metastasis. IF are more common in the curative treatment group than in the postoperative adjuvant group.