@misc{oai:repo.qst.go.jp:00070392,
 author = {Tokumaru, Sunao and Toita, Takafumi and Kato, Shingo and Niibe, Yuzuru and Kazumoto, Tomoko and Kodaira, Takeshi and Kataoka, Masaaki and Ohno, Tatsuya and Oguchi, Masahiko and Hiraoka, Masahiro and 加藤 眞吾 and 古平 毅 and 大野 達也 and 小口 正彦 and 平岡 真寛},
 month = {Nov},
 note = {Purpose/Objective(s): To investigate the pelvic insufficiency fractures (IF) post definitive pelvic radiotherapy for early stage uterine cervicalcancer, we analyzed the subject in a prospective multi-institutional study (JAROG0401/ JROSG04-2).
\nMaterials/Methods: Between September 2004 and July 2007, 59 eligible patients, all Japanese, were enrolled. Median age was 73 years (range:37-84 years). The eligible patients had squamous cell carcinoma of the uterine cervix, and FIGO stages were Ib1: 35, IIa: 12, IIb: 12, and no pelvic/paraaortic lymphadenopathy. Protocol treatment consisted of whole pelvic external beam radiotherapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions (at point A) without chemotherapy. After radiotherapy, the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of the IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as the signal intensity changes in the bones, both on T1 and T2 weighted images. The patients also evaluated by CTCAE (Common Terminology Criteria for Adverse Events)-v.3.0 every 3
months from 3 until 30 months.
\nResults: Median follow-up was 24 months (range: 3-30 months). The 2-year pelvic IF cumulative occurrence rate was 36% (21pts). On CTCAE-v3.0, G1, G2 and G3 were seen in 12 pts (20%), 6 pts (10%), and 3 pts (5%), respectively. 
Sixteen patients had multiple fractures, so the IF were identified at 44 sites. The pelvic IF were frequently seen at the ileo-cecal joints (32 sites: 72%),and at the pubes (9 sites: 20%). Nine patients complained of pelvic or back pains. All patients' pains were palliated by non-narcotic analgesic drugs.
No patients needed surgical intervention. The higher age (>70y) was thought to be a risk factor of pelvic IF (p=0.03, log-rank test).
\nConclusions: Older cervical cancer patients received pelvic radiotherapy may have some risks to develop pelvic IF. However, less than a half of the patients with IF complained of pains, and the pains caused by IF were treated effectively by non-narcotic analgesic drugs., 52nd ASTRO Annual meeting},
 title = {Insufficiency Fractures after Pelvic Radiotherapy for Uterine Cervical  Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)},
 year = {2010}
}