RESUMEN
PURPOSE: The aim of this study was to investigate whether bone mineral density (BMD) as measured in planning computed tomographies (CTs) by a new method is a risk factor for pelvic insufficiency fractures (PIF) after radio(chemo)therapy (R(C)T) for cervical cancer. METHODS: 62 patients 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 mirrored 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/cm3), V50Gy, Dmean, and Dmax. RESULTS: Out of 62 patients, 6 (9.7%) had a fracture. Two out of the 6 patients had a bilateral fracture with only one of them being symptomatic. PIF patients showed a significantly lower BMD in the sacral and the lumbar vertebrae (pâ¯< 0.05). The BMD of the contoured PIF, however, when comparing to the mPIF, did not reach significance (pâ¯< 0.49). 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. CONCLUSION: The dose does not seem to have a relevant 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.
Asunto(s)
Densidad Ósea , Fracturas Espontáneas/prevención & control , Vértebras Lumbares/efectos de la radiación , Órganos en Riesgo/efectos de la radiación , Fracturas Osteoporóticas/prevención & control , Huesos Pélvicos/efectos de la radiación , Traumatismos por Radiación/prevención & control , Planificación de la Radioterapia Asistida por Computador/métodos , Sacro/efectos de la radiación , Fracturas de la Columna Vertebral/prevención & control , Tomografía Computarizada por Rayos X/métodos , Neoplasias del Cuello Uterino/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia/efectos adversos , Quimioradioterapia/efectos adversos , Terapia Combinada , Susceptibilidad a Enfermedades , Relación Dosis-Respuesta en la Radiación , Femenino , Fracturas Espontáneas/etiología , Humanos , Incidencia , Vértebras Lumbares/química , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Irradiación Linfática/efectos adversos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Minerales/análisis , Fracturas Osteoporóticas/etiología , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/lesiones , Radioterapia Adyuvante/efectos adversos , Factores de Riesgo , Sacro/química , Sacro/diagnóstico por imagen , Sacro/lesiones , Fracturas de la Columna Vertebral/etiología , Neoplasias del Cuello Uterino/terapiaRESUMEN
Pollen analysis was applied to a mummified homicide victim in Nebraska, U.S.A., to determine the location of death. A control sample showed the normal ambient pollen in the garage crime scene. Ambient windborne types, common in the air of the region, dominated the control. Internal samples were analyzed from the sacrum, intestine, and diaphragm. Microfossils were recovered from the rehydrated intestine lumen. The intestinal sample was dominated by Brassica (broccoli). The sacrum sample was high in dietary types but with a showing of ambient types. The pollen from the diaphragm was dominated by ambient pollen similar to the control samples. The discovery of diverse pollen spectra from within a single mummy was unexpected. They show that ingested and inhaled pollen mixed in the corpse. The data linked the decedent to a specific crime scene in her Nebraska home in the southern tier of eastern counties on the border with Kansas.