Hip fractures and pain following proton therapy for management of prostate cancer

Figures & data

Table I. Patient characteristics.

Patient characteristics		No. of patients	%
Age (years)
	< 60	66	17
	60 to < 70	157	43
	70 to < 80	135	35
	80+	24	6
Body mass index
	< 30	284	74
	30+	98	26
Ethnicity
	White	351	92
	Black	25	7
	Hispanic	5	1
	Asian	1	< 1
Diabetes
	Yes	58	15
	No	324	85
Previous fracture
	Yes	30	8
	No	352	92
Hyperlipidemia
	Yes	212	56
	No	170	44
Hypertension
	Yes	201	53
	No	181	47
Arthritis
	Yes	70	18
	No	312	82
Alcohol use
	> 7 drinks weekly	93	24
	< 7 drinks weekly	289	76
Smoking history
	> 10 pack years	129	34
	< 10 pack years	253	66
Glucocorticoid therapy
	> 1 month	32	8
	< 1 month or none	350	92
Androgen deprivation therapy
	Yes	85	22
	No	297	78
Proton dose
	70–74 CGE	16	4
	76 CGE	1	< 1
	78 CGE	216	57
	80 CGE	39	10
	82 CGE	110	29

CGE, Cobalt Gray equivalent.

Table II. Characteristics of three patients who experienced hip fractures.

Patient characteristics	Patient 1	Patient 2	Patient 3
Age (years)	77	77	79
Body mass index	23.2	28.3	21.1
Past medical history	Prior fracture, smoker	Robotic prostatectomy	Arthritis, osteoporosis, degenerative joint disease, steroid use
Disease characteristics	T2cN0M0, Gleason 8, PSA 23.5	Relapse following prostatectomy	T2bN0M0, Gleason 9, PSA 11.6
Disease progression	Yes	No	Yes
Androgen deprivation therapy use	Yes	Yes	Yes
Radiotherapy dose	78 CGE	70 CGE	78 CGE
Time to fracture after radiotherapy	18 & 29 months	33 months	9 months
10-year fracture risk	11%	6.40%	15%
Max/mean femoral neck dose	Right- 36 CGE/33 CGE Left- 35 CGE/32 CGE	31 CGE/27 CGE	36 CGE/34 CGE

CGE, Cobal Gray equivalent; PSA, prostate-specific antigen.

Table III. Pelvic and hip fractures after pelvic irradiation for gynecologic malignancies or prostate cancer.

Study	No. of patients	Cancer site	RT Field	Pelvic fracture rate	Fracture site	Time to fracture
Grigsby et al., Mallinckrodt Institute of Radiology, 1995 [14]	207	Vagina, vulva, cervix, and endometrium	WPRT + groin	11% at 5 years; 15% at 10 years	Femoral neck	N/A
Kwon et al., Samsung Medical Center, 2008 [16]	510	Cervix	WPRT + brachytherapy boost	45.2% at 5 years	PIF	17 months
Oh et al., Samsung Medical Center, 2008 [17]	557	Cervix	WPRT ± brachytherapy boost	19.7% at 5 years	PIF	13 months
Igdem et al., Istanbul Bilim University, 2010 [15]	134	Prostate	WPRT + prostate	6.8% at 5 years	PIF	20 months
Elliot et al., University of Minnesota, 2011 [5]	13,396	Prostate	prostate ± WPRT	8% at 10 years	Hip	N/A
	6974		prostate ± WPRT + ADT	9% at 10 years		N/A

ADT, androgen deprivation therapy; N/A, not available; WPRT, whole-pelvis radiotherapy.

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