{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:09:45Z","timestamp":1789592985020,"version":"build-2803163510"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T00:00:00Z","timestamp":1601942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T00:00:00Z","timestamp":1601942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007653","name":"Universit\u00e4tsklinikum Jena","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007653","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The aim of this study was to investigate whether bone mineral density (BMD) as measured in planning computed tomographies (CTs) by a\u00a0new method is a\u00a0risk factor for pelvic insufficiency fractures (PIF) after radio(chemo)therapy (R(C)T) for cervical cancer.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>62\u00a0patients with cervical cancer who received definitive or adjuvant radio(chemo)therapy between 2013 and 2017 were reviewed. The PIF were detected on follow-up magntic resonance imaging (MRI). The MRI of the PIF patients was registered to the planning CT and the PIF contoured. On the contralateral side of the fracture, a\u00a0mirrored structure of the fracture was generated (mPIF). For the whole sacral bone, three lumbar vertebrae, the first and second sacral vertebrae, and the PIF, we analyzed the BMD (mg\/cm<jats:sup>3<\/jats:sup>), V50Gy, Dmean, and Dmax.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Out of 62\u00a0patients, 6 (9.7%) had a\u00a0fracture. Two out of the 6\u00a0patients had a\u00a0bilateral fracture with only one of them being symptomatic. PIF patients showed a\u00a0significantly lower BMD in the sacral and the lumbar vertebrae (<jats:italic>p<\/jats:italic>\u202f&lt;\u20090.05). The BMD of the contoured PIF, however, when comparing to the mPIF, did not reach significance (<jats:italic>p<\/jats:italic>\u202f&lt;\u20090.49). The difference of the V50Gy of the sacrum in the PIF group compared to the other (OTH) patients, i.e. those without PIF, did not reach significance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The dose does not seem to have a\u00a0relevant impact on the incidence of PIF in our patients. One of the predisposing factors for developing PIF after radiotherapy seems to be the low BMD. We presented an easy method to assess the BMD in planning CTs.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00066-020-01690-0","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T23:05:08Z","timestamp":1602025508000},"page":"487-493","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiotherapy for cervical cancer"],"prefix":"10.1007","volume":"197","author":[{"given":"Drilon","family":"Kurrumeli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Oechsner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Weidenb\u00e4cher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Brambs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"L\u00f6ffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie Elisabeth","family":"Combs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Borm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0205-4411","authenticated-orcid":false,"given":"Marciana Nona","family":"Duma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,6]]},"reference":[{"issue":"15","key":"1690_CR1","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1056\/NEJM199904153401501","volume":"340","author":"M Morris","year":"1999","unstructured":"Morris\u00a0M et al (1999) Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N\u00a0Engl J Med 340(15):1137\u20131143","journal-title":"N Engl J Med"},{"issue":"15","key":"1690_CR2","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1056\/NEJM199904153401503","volume":"340","author":"HM Keys","year":"1999","unstructured":"Keys\u00a0HM et\u00a0al (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N\u00a0Engl J Med 340(15):1154\u20131161","journal-title":"N Engl J Med"},{"issue":"5","key":"1690_CR3","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1001\/jama.1995.03530050035029","volume":"274","author":"M Rotman","year":"1995","unstructured":"Rotman\u00a0M et al (1995) Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA 274(5):387\u2013393","journal-title":"JAMA"},{"issue":"2","key":"1690_CR4","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1006\/gyno.1999.5387","volume":"73","author":"A Sedlis","year":"1999","unstructured":"Sedlis\u00a0A et\u00a0al (1999) A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study. Gynecol Oncol 73(2):177\u2013183","journal-title":"Gynecol Oncol"},{"issue":"15","key":"1690_CR5","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1056\/NEJM199904153401502","volume":"340","author":"PG Rose","year":"1999","unstructured":"Rose\u00a0PG et al (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N\u00a0Engl J Med 340(15):1144\u20131153","journal-title":"N Engl J Med"},{"key":"1690_CR6","unstructured":"Leitlinienprogramm Onkologie (2014) S3-Leitlinie Diagnostik und Therapie Nachsorge der Patientin mit Zervixkarzinom. https:\/\/www.leitlinienprogramm-onkologie.de\/fileadmin\/user_upload\/Downloads\/Leitlinien\/Zervixkarzinom\/LL_Zervixkarzinom_Langversion_1.0.pdf. Accessed 2019"},{"issue":"1","key":"1690_CR7","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1148\/radiology.156.1.4001403","volume":"156","author":"KL Cooper","year":"1985","unstructured":"Cooper\u00a0KL, Beabout\u00a0JW, Swee\u00a0RG (1985) Insufficiency fractures of the sacrum. Radiology 156(1):15\u201320","journal-title":"Radiology"},{"issue":"5","key":"1690_CR8","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.2214\/ajr.167.5.8911181","volume":"167","author":"V Blomlie","year":"1996","unstructured":"Blomlie\u00a0V et al (1996) Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR Am J Roentgenol 167(5):1205\u20131210","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"1690_CR9","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1006\/gyno.2002.6756","volume":"86","author":"SJ Huh","year":"2002","unstructured":"Huh\u00a0SJ et\u00a0al (2002) Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol 86(3):264\u2013268","journal-title":"Gynecol Oncol"},{"issue":"2","key":"1690_CR10","doi-asserted-by":"publisher","first-page":"e195","DOI":"10.1016\/j.ijrobp.2012.03.042","volume":"84","author":"S Tokumaru","year":"2012","unstructured":"Tokumaru\u00a0S et al (2012) Insufficiency fractures after pelvic radiation therapy for uterine cervical cancer: an analysis of subjects in a\u00a0prospective multi-institutional trial, and cooperative study of the Japan radiation oncology group (JAROG) and Japanese radiation oncology study group (JROSG). Int J Radiat Oncol Biol Phys 84(2):e195\u2013200","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"5","key":"1690_CR11","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1016\/j.ijrobp.2017.01.026","volume":"97","author":"A Ramlov","year":"2017","unstructured":"Ramlov\u00a0A et\u00a0al (2017) Risk factors for pelvic insufficiency fractures in locally advanced cervical cancer following intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 97(5):1032\u20131039","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"4","key":"1690_CR12","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1016\/j.ijrobp.2007.08.005","volume":"70","author":"D Oh","year":"2008","unstructured":"Oh\u00a0D et\u00a0al (2008) Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: analysis of risk factors. Int J Radiat Oncol Biol Phys 70(4):1183\u20131188","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"1690_CR13","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1002\/cncr.24811","volume":"116","author":"KM Schmeler","year":"2010","unstructured":"Schmeler\u00a0KM et\u00a0al (2010) Pelvic fractures after radiotherapy for cervical cancer: implications for survivors. Cancer 116(3):625\u2013630","journal-title":"Cancer"},{"issue":"6","key":"1690_CR14","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1093\/jrr\/rrt055","volume":"54","author":"H Uezono","year":"2013","unstructured":"Uezono\u00a0H et\u00a0al (2013) Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors. J\u00a0Radiat Res 54(6):1102\u20131109","journal-title":"J Radiat Res"},{"issue":"8","key":"1690_CR15","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.3174\/ajnr.A3893","volume":"35","author":"BJ Schwaiger","year":"2014","unstructured":"Schwaiger\u00a0BJ et\u00a0al (2014) Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol 35(8):1628\u20131633","journal-title":"AJNR Am J Neuroradiol"},{"issue":"4","key":"1690_CR16","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/j.ijrobp.2012.01.064","volume":"84","author":"V Gondi","year":"2012","unstructured":"Gondi\u00a0V et al (2012) Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis. Int J Radiat Oncol Biol Phys 84(4):973\u2013982","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1073","key":"1690_CR17","doi-asserted-by":"publisher","first-page":"20160885","DOI":"10.1259\/bjr.20160885","volume":"90","author":"L Bazire","year":"2017","unstructured":"Bazire\u00a0L et al (2017) Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature. Br J Radiol 90(1073):20160885","journal-title":"Br J Radiol"},{"issue":"3","key":"1690_CR18","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.ijrobp.2019.09.012","volume":"106","author":"LG Sapienza","year":"2020","unstructured":"Sapienza\u00a0LG et al (2020) 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 106(3):475\u2013484","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"1690_CR19","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.ejrad.2008.04.059","volume":"71","author":"C Krestan","year":"2009","unstructured":"Krestan\u00a0C, Hojreh\u00a0A (2009) Imaging of insufficiency fractures. Eur J Radiol 71(3):398\u2013405","journal-title":"Eur J Radiol"}],"container-title":["Strahlentherapie und Onkologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-020-01690-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00066-020-01690-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-020-01690-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T04:36:46Z","timestamp":1633495006000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00066-020-01690-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,6]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["1690"],"URL":"https:\/\/doi.org\/10.1007\/s00066-020-01690-0","relation":{},"ISSN":["0179-7158","1439-099X"],"issn-type":[{"value":"0179-7158","type":"print"},{"value":"1439-099X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,6]]},"assertion":[{"value":"23 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"S.E.\u00a0Combs: Advisory Boards\/Advisor: BMS, Astra Zeneca, Roche, Novocure, Daiichi Sankyo, Icotec; Speakers Honoraria: BMS, Astra Zeneca, Roche, Novocure, Daiichi Sankyo, Icotec, Brainlab, varian, Accuray, Zeiss Meditec, Dr. Sennewald, Elekta, Merck Darmstadt, Medac. D.\u00a0Kurrumeli, M.\u00a0Oechsner, B.\u00a0Weidenb\u00e4cher, C.\u00a0Brambs, M.\u00a0L\u00f6ffler, K.\u00a0Borm, and M.N.\u00a0Duma declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}