In this study, we reviewed CT/MRI scans and studied the rates of radiation-related fractures in subjects treated for cervical cancer (CC, 63 subjects) by radical radiotherapy (RT) and in subjects treated for endometrial cancer (EC, 64 subjects) by radical surgery and RT. The differences between bone density measured in L1 on pretreatment CT, age and body mass index (BMI) were evaluated. Despite significant differences in RT total dose, age, BMI, etc., between both groups, the rate of radiation-related fractures was similar: 28.6% of CC versus 26.6% of EC subjects. CC subjects with fractures were significantly older (62.4 ± 10.1 vs. 49.0 ± 12.4 years; p < 0.001), and their bone densities were significantly lower (106.3 ± 40.0 vs. 168.2 ± 49.5 HU; p < 0.001); no difference in BMI was found. EC subjects with fractures were without significant difference in age but had significantly lower bone densities (103.8 ± 29.0 vs. 133.8 ± 42.3 HU; p = 0.009) and BMIs (26.1 ± 4.9 vs. 31.8 ± 6.9 kg/m2; p = 0.003). Bone density strongly correlated with age (r = -0.755) only in CC subjects. Subjects with fractures from both groups had similarly low bone densities (106.3 ± 40.0 vs. 103.8 ± 29.0 HU; p = 0.829); however, no correlation between bone density and BMI was found. The rate of radiation-related fractures in both groups was clearly associated only with low pretreatment bone density, reflecting osteoporosis.

Department of Obstetrics and Gynaecology 3rd Faculty of Medicine Charles University Faculty Hospital Kralovske Vinohrady 11000 Prague Czech Republic

Department of Oncology 3rd Faculty of Medicine Charles University Faculty Hospital Kralovske Vinohrady 11000 Prague Czech Republic

Department of Radiology and Nuclear Medicine 3rd Faculty of Medicine Charles University Faculty Hospital Kralovske Vinohrady 11000 Prague Czech Republic

Institute of Anatomy 2nd Faculty of Medicine Charles University 11000 Prague Czech Republic

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Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021;71:209–249. doi: 10.3322/caac.21660. PubMed DOI

Wilailak S., Kengsakul M., Kehoe S. Worldwide initiatives to eliminate cervical cancer. Int. J. Gynaecol. Obstet. 2021;155:102–106. doi: 10.1002/ijgo.13879. PubMed DOI PMC

da Mata S., Ferreira J., Nicolás I., Esteves S., Esteves G., Lérias S., Silva F., Saco A., Cochicho D., Cunha M., et al. P16 and HPV Genotype Significance in HPV-Associated Cervical Cancer—A Large Cohort of Two Tertiary Referral Centers. Int. J. Mol. Sci. 2021;22:2294. doi: 10.3390/ijms22052294. PubMed DOI PMC

Koskas M., Amant F., Mirza M.R., Creutzberg C.L. Cancer of the corpus uteri: 2021 update. Int. J. Gynaecol. Obstet. 2021;155:45–60. doi: 10.1002/ijgo.13866. PubMed DOI PMC

Dörk T., Hillemanns P., Tempfer C., Breu J., Fleisch M.C. Genetic Susceptibility to Endometrial Cancer: Risk Factors and Clinical Management. Cancers. 2020;12:2407. doi: 10.3390/cancers12092407. PubMed DOI PMC

Bhatla N., Aoki D., Sharma D.N., Sankaranarayanan R. Cancer of the cervix uteri. Int. J. Gynaecol. Obstet. 2018;143:22–36. doi: 10.1002/ijgo.12611. PubMed DOI

Malikova H., Burghardtova M., Fejfarova K., Nadova K., Weichet J. Advanced cervical cancer in young women: Imaging study of late and very late radiation-related side effects after successful treatment by combined radiotherapy. Quant. Imaging Med. Surg. 2021;11:21–31. doi: 10.21037/qims-20-553. PubMed DOI PMC

Pillai A.K., Anderson M.E., Reddick M.A., Sutphin P.D., Kalva S.P. Ureteroarterial fistula: Diagnosis and management. Am. J. Roentgenol. 2015;204:W592–W5928. doi: 10.2214/AJR.14.13405. PubMed DOI

Singh G.K., Yadav V., Singh P., Bhowmik K.T. Radiation-Induced Malignancies Making Radiotherapy a “Two-Edged Sword”: A Review of Literature. World J. Oncol. 2017;8:1–6. doi: 10.14740/wjon996w. PubMed DOI PMC

Cahan W.G., Woodard H.Q., Higinbotham N.L., Stewart F.W., Coley B.L. Sarcoma arising in irradiated bone: Report of eleven cases. Cancer. 1998;82:8–34. doi: 10.1002/(SICI)1097-0142(19980101)82:1<8::AID-CNCR3>3.0.CO;2-W. PubMed DOI

Hall E.J., Wuu C.S. Radiation-induced second cancers: The impact of 3D-CRT and IMRT. Int. J. Radiat. Oncol. Biol. Phys. 2003;56:83–88. doi: 10.1016/S0360-3016(03)00073-7. PubMed DOI

Viswanathan A.N., Lee L.J., Eswara J.R., Horowitz N.S., Konstantinopoulos P.A., Mirabeau-Beale K.L., Rose B.S., von Keudell A.G., Wo J.Y. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014;120:3870–3883. doi: 10.1002/cncr.28849. PubMed DOI

Nadova K., Burghardtova M., Fejfarova K., Reginacova K., Malikova H. Late Radiation-Related Toxicities in Patients Treated for Early-Stage Cervical Carcinoma by Surgery and Adjuvant Radiotherapy: A Retrospective Imaging Study. Pathol. Oncol. Res. 2021;27:1609915. doi: 10.3389/pore.2021.1609915. PubMed DOI PMC

Kwon J.W., Huh S.J., Yoon Y.C., Choi S.H., Jung J.Y., Oh D., Choe B.K. Pelvic bone complications after radiation therapy of uterine cervical cancer: Evaluation with MRI. Am. J. Roentgenol. 2008;191:987–994. doi: 10.2214/AJR.07.3634. PubMed DOI

Papadopoulou I., Stewart V., Barwick T.D., Park W.H., Soneji N., Rockall A.G., Bharwani N. Post-Radiation Therapy Imaging Appearances in Cervical Carcinoma. Radiographics. 2016;36:538–553. doi: 10.1148/rg.2016150117. PubMed DOI

Chung Y.K., Lee Y.K., Yoon B.H., Suh D.H., Koo K.H. Pelvic Insufficiency Fractures in Cervical Cancer after Radiation Therapy: A Meta-Analysis and Review. Vivo. 2021;35:1109–1115. doi: 10.21873/invivo.12356. PubMed DOI PMC

Uezono H., Tsujino K., Moriki K., Nagano F., Ota Y., Sasaki R., Soejima T. Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: Retrospective analysis of risk factors. J. Radiat. Res. 2013;54:1102–1109. doi: 10.1093/jrr/rrt055. PubMed DOI PMC

Nicolay N.H., Sommer E., Lopez R., Wirkner U., Trinh T., Sisombath S., Debus J., Ho A.D., Saffrich R., Huber P.E. Mesenchymal stem cells retain their defining stem cell characteristics after exposure to ionizing radiation. Int. J. Radiat. Oncol. Biol. Phys. 2013;87:1171–1178. doi: 10.1016/j.ijrobp.2013.09.003. PubMed DOI

Yaprak G., Gemici C., Temizkan S., Ozdemir S., Dogan B.C., Seseogullari O.O. Osteoporosis development and vertebral fractures after abdominal irradiation in patients with gastric cancer. BMC Cancer. 2018;18:972. doi: 10.1186/s12885-018-4899-z. PubMed DOI PMC

Vitzthum L.K., Park H., Zakeri K., Heide E.S., Nalawade V., Mundt A.J., Vaida F., Murphy J.D., Mell L.K. Risk of Pelvic Fracture With Radiation Therapy in Older Patients. Int. J. Radiat. Oncol. Biol. Phys. 2020;106:485–492. doi: 10.1016/j.ijrobp.2019.10.006. PubMed DOI PMC

Schmeler K.M., Jhingran A., Iyer R.B., Sun C.C., Eifel P.J., Soliman P.T., Ramirez P.T., Frumovitz M., Bodurka D.C., Sood A.K. Pelvic fractures after radiotherapy for cervical cancer: Implications for survivors. Cancer. 2010;116:625–630. doi: 10.1002/cncr.24811. PubMed DOI PMC

Salcedo M.P., Sood A.K., Jhingran A., Eifel P.J., Klopp A.H., Iyer R.B., Fellman B.M., Jimenez C., Schmeler K.M. Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer: A prospective study of 239 women. Cancer. 2020;126:2607–2613. doi: 10.1002/cncr.32807. PubMed DOI PMC

Kurrumeli D., Oechsner M., Weidenbächer B., Brambs C., Löffler M., Combs S.E., Borm K., Duma M.N. An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiotherapy for cervical cancer. Strahlenther Onkol. 2021;197:487–493. doi: 10.1007/s00066-020-01690-0. PubMed DOI PMC

Abbouchie H., Raju N., Lamanna A., Chiang C., Kutaiba N. Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population. Clin. Radiol. 2022;77:e540–e548. doi: 10.1016/j.crad.2022.04.002. PubMed DOI

Faye M.D., Alfieri J. Advances in Radiation Oncology for the Treatment of Cervical Cancer. Curr. Oncol. 2022;29:928–944. doi: 10.3390/curroncol29020079. PubMed DOI PMC

Kronborg C.J., Pedersen B.G., Klemmensen J., Lefévre A.C., Wind K.L., Spindler K.G. Pelvic Insufficiency Fractures and Bone Pain after Radiation Therapy for Anal Cancer: Relation to Pelvic Bone Dose-Volume Parameters. Adv. Radiat. Oncol. 2022;8:101110. doi: 10.1016/j.adro.2022.101110. PubMed DOI PMC

Kronborg C.J.S., Jørgensen J.B., Petersen J.B.B., Jensen L.N., Iversen L.H., Pedersen B.G., Spindler K.-L.G. Pelvic insufficiency fractures, dose volume parameters and plan optimization after radiotherapy for rectal cancer. Clin. Transl. Radiat. Oncol. 2019;19:72–76. doi: 10.1016/j.ctro.2019.09.001. PubMed DOI PMC

Sini C., Fiorino C., Perna L., Noris Chiorda B., Deantoni C.L., Bianchi M., Sacco V., Briganti A., Montorsi F., Calandrino R., et al. Dose-volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation. Radiother. Oncol. 2016;118:79–84. doi: 10.1016/j.radonc.2015.11.020. PubMed DOI

Sapienza L.G., Salcedo M.P., Ning M.S., Jhingran A., Klopp A.H., Calsavara V.F., Schmeler K.M., Leite Gomes M.J., de Freitas Carvalho E., Baiocchi G. Pelvic Insufficiency Fractures After External Beam Radiation Therapy for Gynecologic Cancers: A Meta-analysis and Meta-regression of 3929 Patients. Int. J. Radiat. Oncol. Biol. Phys. 2020;106:475–484. doi: 10.1016/j.ijrobp.2019.09.012. PubMed DOI

Lukka H., Hirte H., Fyles A., Thomas G., Elit L., Johnston M., Fung M.F., Browman G. Cancer Care Ontario Practice Guidelines Initiative Gynecology Disease Site Group. Concurrent cisplatin-based chemotherapy plus radiotherapy for cervical cancer--a meta-analysis. Clin. Oncol. 2002;14:203–212. doi: 10.1053/clon.2002.0076. PubMed DOI

Shrivastava S., Mahantshetty U., Engineer R., Chopra S., Hawaldar R., Hande V., Kerkar R.A., Maheshwari A., Shylasree T.S., Ghosh J., et al. Gynecologic Disease Management Group. Cisplatin Chemoradiotherapy vs Radiotherapy in FIGO Stage IIIB Squamous Cell Carcinoma of the Uterine Cervix: A Randomized Clinical Trial. JAMA Oncol. 2018;4:506–513. doi: 10.1001/jamaoncol.2017.5179. PubMed DOI PMC

Misra S., Lal P., Kumar Ep S., Rastogi N., Tiwari A., Singh S., Das K.J.M., Kumar S. Comparative assessment of late toxicity in patients of carcinoma cervix treated by radiotherapy versus chemo-radiotherapy—Minimum 5 years follow up. Cancer Treat. Res. Commun. 2018;14:30–36. doi: 10.1016/j.ctarc.2017.11.007. PubMed DOI

Comparison of tracer application methods for sentinel lymph node detection in open surgery patients with endometrial cancer: a retrospective cohort study