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Insufficiency Fractures After Radiation Therapy: An Update

  • Geriatrics (G Guglielmi, Section Editor)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Radio therapy, alone or in combination with surgery and/or chemotherapy, is commonly used to treat a variety of neoplasms, resulting in effective local tumor control. Unfortunately radiation therapy can also change the structure of the skeletal system, leading to edema, vascular congestion, areas of hemorrhage, loss of cellularity, focal bone marrow changes, fatty transformation, osteitis, hematopoietic marrow regeneration, osteolysis of symphysis pubis or sacroiliac joints, avascular necrosis, insufficiency fractures, osteoradionecrosis, and radiation-induced neoplasms.

Recent Findings

The various radiotherapy effects can be studied and diagnosed by analyzing MR signal intensity, CT attenuation, and FDG-PET activity.

Summary

In this review, we report a complete analysis of side effects of radiotherapy on bones, focusing on the spine, chest wall, and pelvis.

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Abbreviations

CT:

Computed tomography

D 0.5:

Dose of RT at 0.5% of rib

EBRT:

External beam RT

HDR-ICBT:

High-dose-rate intracavitary brachytherapy

MRI:

Magnetic resonance imaging

NSCLC:

Non-small-cell lung cancer

PIF:

Pelvic insufficiency fracture

SBRT:

Stereotactic body radiotherapy

SINS:

Spinal instability neoplastic score

SRS:

Stereotactic radiosurgery

V25:

Volume of rib receiving at least 25 Gy

VCF:

Vertebral compression fractures

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Authors and Affiliations

  1. Unit of Radiation Oncology of IRCCS CROB, Rionero in Vulture, Potenza, Italy

    Vincenzo Fusco & Rocchina Caivano

  2. Unit of Radiation Therapy of I.R.C.C.S. “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

    Salvatore Parisi, Michele Troiano, Pietro Corsa, Arcangela Raguso & Tindara Munafò

  3. Unit of Radiology of I.R.C.C.S. “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

    Giuseppe Guglielmi

  4. Department of Radiology, University of Foggia, Foggia, Italy

    Maria Antonietta Clemente & Giuseppe Guglielmi

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  1. Vincenzo Fusco
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Correspondence to Giuseppe Guglielmi.

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Conflict of interest

Vincenzo Fusco, Rocchina Caivano, Salvatore Parisi, M. Troiano, Pietro Corsa, Arcangela Raguso, Tindara Munafò, and Maria A. Clemente each declare no potential conflicts of interest. Giuseppe Guglielmi is a section editor for Current Radiology Reports.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical collection on Geriatrics.

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Fusco, V., Caivano, R., Parisi, S. et al. Insufficiency Fractures After Radiation Therapy: An Update. Curr Radiol Rep 6, 21 (2018). https://doi.org/10.1007/s40134-018-0280-x

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