Loss of bone mineral density (BMD) and pelvic insufficiency fractures (PIF) are well-documented complications of external beam radiotherapy for gynaecological malignancies and contribute to significant post-treatment morbidity and mortality1,2. Recent prospective studies and metanalyses report the prevalence of PIFs post radiotherapy as 7.8%-14% with most occurring within 2 years post treatment2–4. Currently no consensus guideline exists for the risk stratification of these patients and as such it remains an area in need of further research5. This study will aim to provide a preliminary understanding of...

This retrospective study was completed as a file review of patients who underwent treatment for gynaecological malignancies at a single metropolitan hospital from 2020-2023. For inclusion in the study, patients needed to have a gynaecological malignancy being treated with curative intent, received external beam radiotherapy to the pelvis (+/- Para-Aortic region), ECOG 0-2, and have a recorded baseline Quantitative Computed Tomography (QCT) BMD scan prior to treatment with a repeat scan within 18 months post treatment. Exclusion criteria were patients receiving with palliative intent radiotherapy,...

127 patients were identified as having received pelvic radiotherapy for gynaecological malignancies with curative intent at our centre from 2020-2023. Of these patients, 24 met the inclusion criteria. The patients analysed were predominantly post-menopausal at diagnosis (21/24), non-smokers (19/24) with mean age of 63.2 (45-85) and ECOG of 0-2. Endometrial cancer was the most common primary site of malignancy (20/24). 18/24 underwent chemotherapy as part of their treatment, with 8 patients receiving carboplatin/paclitaxel prior to treatment and 10 patients receiving concurrent cisplatin with radiotherapy. The...

This data demonstrates that the majority of patients treated with external beam radiotherapy for underlying Gynaecological malignancy developed severe osteoporosis or progressive bone loss at either the left femoral neck or lumbar spine. A more pronounced decrease in BMD was noted in the lumbar spine compared to the femoral neck. The effect of treatment field size was deemed to be a significant factor in lumbar spine bone loss. Radiotherapy dose was found to be directly correlated to BMD loss at the L3 vertebrae, however this...

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet Lond Engl. 1999 Mar 13;353(9156):878–82. Salcedo MP, Sood AK, Jhingran A, Eifel PJ, Klopp AH, Iyer RB, et al. 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(11):2607–13. Sapienza LG, Salcedo MP, Ning MS, Jhingran A, Klopp AH, Calsavara VF, et al. Pelvic Insufficiency...