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  • [Clin Breast Cancer.] Spontaneous Rib Fractures After Breast Cancer Treatment Based on Bone Scans: Comparison Of Conventional Versus Hypofractionated Radiotherapy

    서울의대 / 김도욱, 신경환*

  • 출처
    Clin Breast Cancer.
  • 등재일
    2021 Feb
  • 저널이슈번호
    21(1):e80-e87. doi: 10.1016/j.clbc.2020.07.009. Epub 2020 Jul 23.
  • 내용

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    Abstract
    Background: Spontaneous rib fractures (SRFs) are defined as fractures without apparent blunt force trauma. This study evaluated the incidence and risk factors of SRFs after treatment of patients with breast cancer based on bone scans. In addition, we analyzed radiation-associated SRFs and identified radiotherapy (RT) factors related to SRF.

    Patients and methods: We retrospectively reviewed 1265 patients with breast cancer who underwent surgery in 2015 at our institution, and were followed-up with at least 3 bone scans. Bone scans were conducted approximately every 12 months after breast cancer treatment. The endpoint was SRF detected by bone scan. In this study, 754 (60%) patients were treated with chemotherapy, 867 (69%) with RT, and 946 (75%) with anti-hormone therapy.

    Results: The median follow-up duration was 37.5 months. A total of 209 (16.5%) patients experienced SRFs during follow-up. The incidence of SRFs increased sharply during the 3-year follow-up period after completion of treatment. In multivariate analyses, abnormal bone density, chemotherapy, and RT were significant risk factors for SRFs. In patients treated with RT (n = 867), 159 (18%) rib fractures occurred: 127 (80%) in the ipsilateral breast and 32 (20%) in the contralateral breast. Among the patients with ipsilateral SRFs who received tumor bed boost (n = 84), the SRF occurred inside the boost field in 80 (95%) cases. Multivariate analysis of RT subgroups showed that hypofractionated RT increased the rate of SRFs (P = .002).

    Conclusions: Most of the rib fractures that occurred after treatment were spontaneous. Hypofractionated RT increased the risk of ipsilateral rib fractures in RT-treated patients.

     

     

     

     

    Affiliations

    Do Wook Kim  1 , Jae Sik Kim  1 , Kyubo Kim  2 , Kyung Hwan Shin  3
    1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
    2 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
    3 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: shin.kyunghwan@gmail.com.

  • 키워드
    Breast cancer; Fractionation; Postoperative treatment; Radiation therapy; Rib fracture.
  • 편집위원

    유방암에서 통상분할방사선치료와 소분할방사선치료를 비교했을 때, 뼈스캔에서 관찰되는 늑골골절 빈도가 소분할방사선치료 군에서 높게 관찰됨

    2021-03-25 14:54:52

  • 편집위원

    대부분 치료가 필요없는 spontaneous rib fracure이지만 2.7-3.85 Gy/fx (total dose 38.5-45.9 Gy)의 hypofractionation regimen에서도 conventional fractionation에 비해 발생빈도가 증가한다는 흥미로운 연구결과입니다.

    2021-03-25 15:01:00

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