Author: By Lynda Williams, Senior medwireNews Reporter
medwireNews: A study of Japanese patients treated for oesophageal cancer has identified a higher risk of thoracic vertebral fracture with radiotherapy compared with other treatment modalities.
Finding a significant correlation between radiation dose to a single vertebra and risk of fracture, the study authors write in JAMA Network Open that “[a] reduced radiation dose to thoracic vertebrae may decrease the incidence of fractures.”
Katsuyuki Sakanaka, from Kyoto University in Japan, and co-workers reviewed medical records for 315 patients who were treated for stage I–III thoracic oesophageal cancer between 2007 and 2013, 119 of whom underwent chemoradiotherapy and 196 who were instead treated surgically, with or without neoadjuvant chemotherapy, or endoscopically.
After a median 40.4 months of follow-up, 16.8% of the chemoradiotherapy group had sustained a thoracic vertebral fracture compared with just 4.1% of those treated surgically or endoscopically. This gave 36-month incidence rates of 12.3% and 3.5%, respectively, and a significant hazard ratio (HR) for fracture of 3.41 with use of chemoradiotherapy.
Multivariable analysis confirmed that receipt of chemoradiotherapy was associated with a significant increased risk for vertebral fracture after adjusting for sex (HR=3.91), age (HR=3.14) and a history of vertebral or hip fracture (HR=3.10).
Moreover, each 5 Gy increase in average radiation dose to a single vertebra was associated with a 1.19-fold increased risk for thoracic vertebral fracture, the team reports.
Discussing the findings in an accompanying commentary, Cristina DeCesaris and Avani Rao, from the University of Maryland in Baltimore, USA, note that the analysis lacks information on possible confounding factors, such as baseline bone density, and does not include a healthy cohort for comparison.
Nevertheless, they write that “this study raises attention to an important treatment-related morbidity that can be overlooked by radiation oncologists and has implications for future radiotherapy planning and patient counseling and survivorship.”
Emphasizing the importance of minimising radiation exposure to the bone and bone marrow, the commentators say that “[b]ecause advanced radiation modalities are increasingly used, physicians will have the capability to deliver highly conformal plans and may have the ability to significantly decrease radiation exposure to the vertebral bodies, if it is an established planning goal.”
References
Fujii K, Sakanaka K, Uozumi R, et al. Association of chemoradiotherapy with thoracic vertebral fractures in patients with esophageal cancer. JAMA Netw Open; 3: e2013952. Published online 1 September 2020. doi:10.1001/jamanetworkopen.2020.13952
DeCesaris C, Rao AD. Characterizing the risk of vertebral body fractures in patients receiving chemoradiotherapy for esophageal cancer. JAMA Netw Open; 3: e2014340. Published online 1 September 2020. doi:10.1001/jamanetworkopen.2020.14340
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