TY - JOUR
T1 - Non-traumatic vertebral fractures in patients with locally advanced esophageal cancer
T2 - A previously unreported, unrecognized problem
AU - McKean, H.
AU - Miller, R. C.
AU - Jatoi, Aminah
PY - 2007/4
Y1 - 2007/4
N2 - Recent studies suggest cancer therapy may compromise bone integrity. What is the rate of vertebral fractures among patients who have received trimodality therapy (radiation, chemotherapy, and surgery) for locally advanced esophageal cancer? This single-institution, retrospective study attempted to answer this question, focusing on 337 patients who had received trimodality therapy for locally advanced esophageal cancer between 1996 and 2005. Reports of serial radiographs were reviewed to identify vertebral fractures. Duration of follow-up was gathered for all esophageal cancer patients with the intention of calculating fracture incidence rates. Fracture-related symptoms, types of intervention and fracture recurrence were also gleaned from the clinical records. First-time fractures were identified in 47 patients, and 45 of these were new since the cancer diagnosis. Thus, the first-time fracture incidence rate from the time of cancer diagnosis was 12 fractures per 100 patient years. The median time from cancer diagnosis to fracture was 9 months. Fifteen (33%) patients were symptomatic. Acknowledging that a retrospective study can inadvertently result in information omission, we report that pain medications were started in only seven patients (16%), and osteoporosis medication in only six (13%). Two patients were hospitalized, and two underwent vertebroplasty. The median survival after fracture diagnosis was 36 months. This report describes a seemingly high fracture incidence rate that requires confirmation. If confirmed, future studies should focus on identifying risk factors and optimal strategies for the prevention and treatment of vertebral fractures in patients with esophageal cancer.
AB - Recent studies suggest cancer therapy may compromise bone integrity. What is the rate of vertebral fractures among patients who have received trimodality therapy (radiation, chemotherapy, and surgery) for locally advanced esophageal cancer? This single-institution, retrospective study attempted to answer this question, focusing on 337 patients who had received trimodality therapy for locally advanced esophageal cancer between 1996 and 2005. Reports of serial radiographs were reviewed to identify vertebral fractures. Duration of follow-up was gathered for all esophageal cancer patients with the intention of calculating fracture incidence rates. Fracture-related symptoms, types of intervention and fracture recurrence were also gleaned from the clinical records. First-time fractures were identified in 47 patients, and 45 of these were new since the cancer diagnosis. Thus, the first-time fracture incidence rate from the time of cancer diagnosis was 12 fractures per 100 patient years. The median time from cancer diagnosis to fracture was 9 months. Fifteen (33%) patients were symptomatic. Acknowledging that a retrospective study can inadvertently result in information omission, we report that pain medications were started in only seven patients (16%), and osteoporosis medication in only six (13%). Two patients were hospitalized, and two underwent vertebroplasty. The median survival after fracture diagnosis was 36 months. This report describes a seemingly high fracture incidence rate that requires confirmation. If confirmed, future studies should focus on identifying risk factors and optimal strategies for the prevention and treatment of vertebral fractures in patients with esophageal cancer.
KW - Esophageal cancer
KW - Osteoporosis
KW - Pain
KW - Vertebral fractures
UR - http://www.scopus.com/inward/record.url?scp=34147136570&partnerID=8YFLogxK
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U2 - 10.1111/j.1442-2050.2007.00645.x
DO - 10.1111/j.1442-2050.2007.00645.x
M3 - Article
C2 - 17439592
AN - SCOPUS:34147136570
SN - 1120-8694
VL - 20
SP - 102
EP - 106
JO - Diseases of the Esophagus
JF - Diseases of the Esophagus
IS - 2
ER -