JAMA Network Open: The relationship between chemotherapy and thoracic fractures in patients with esophageal cancer.

Vertebral fractures are the most common osteoporosis fractures in adults.
age, gender, body mass index, history of osteoporosis fractures, history of smoking, history of oral glucoticoids, history of alcohol consumption, history of parental hip fractures, low HU values are considered risk factors for vertebral fractures.
vertebral fractures reduced the patient's ability to activity and quality of life, and increased mortality.
there have been many studies on the radiotherapy of malignant tumors associated with vertebral fractures.
Such as preoperative chemotherapy (CRT), local late-stage non-small cell lung cancer radiotherapy, and stereotactic radiation therapy of spinal tumors, the cumulative incidence of vertebral fractures in 1 to 2 years was 8% to 19%.
the risk of these vertebral fractures is higher than that of general osteoporosis fractures.
, however, two key defects are prevalent in those reports that prove radiotherapy is associated with vertebral fractures.
, these reports are based only on studies that measure the incidence of radiation therapy.
their report did not set up a control group and failed to weaken the effects of confuse factors, such as malignant tumors, which are a risk factor for spinal fractures.
, previous reports have not taken into account the tendency of thoracic fractures.
thoracic fractures, which often occur in vertebrae 7, 8, 11 or 12, did not analyze the relationship between the exposure to the wild or the dose of exposure to the location of the vertebral fractures.
these conditions, esophageal squamous cell carcinoma is considered suitable for assessing the correlation between radiation therapy and thoracic fractures.
, unlike adenocarcinoma at the junction of the gastroesophageal esophageal, squamous cell carcinoma originates in the thoracic esophageal.
treatment is multi-mode, including endoscopic therapy, surgery and simultaneous chemotherapy (CRT) for tumors.
this feature allows us to compare the rate of vertebral fractures in these patients receiving radiation therapy.
second, esophageal cancer radiotherapy is wide-ranging, irradiated wild including primary tumors, metastatic vertical lymph nodes and thoracic esophageal, most thoracic spines are included in the irradiated field.
allows us to investigate whether there is a link between the dose of exposure to a single vertebrae and vertebral fractures.
recently, a study on JAMA Network Open explored the relationship between chemotherapy and thoracic fractures in patients with esophageal cancer.
retrospective team study included patients with clinical stage I to III thoracic esophageal cancer who were treated at Kyoto University Hospital in Japan from January 1, 2007 to December 31, 2013.
analyzed data from April 6, 2018 to June 4, 2020, and the study focused on the cumulative occurrence of thoracic fractures over a 36-month 36-month 36-month 36-month term.
possible risk factors, including CRT, were also discussed in multivariate analysis, and the relationship between radiation dose and vertebral fractures was evaluated.
315 patients included in the analysis had a medium age of 65 years (range 32-85 years), 56 (17.8%) were women and 259 male patients (82.2%).
observation time was 40.4 (0.7-124.1) months overall, the CRT group was 40.3 (4.0-122.7) months, and the non-CRT group was 40.6 (0.7-124.1) months.
baseline characteristics of patients showed that the cumulative rate of thoracic fractures in the 36-month chemotherapy group was 12.3% (95% CI: 7.0%-19.1%).
the cumulative occurrence of thoracic fractures in the CRT group was higher than in the non-CRT group (3.5% (95% CI, 1.3%-7.5%).
analysis of the cumulative occurrence of thoracic fractures showed that, after gender adjustment, the HR of thoracic fractures in the CRT group and non-CRT group was 3.91 (95% CI, 1.66-9.23; P-0.002) and the age-adjusted HR was 3.92. 14 (95%CI, 1.37-7.19; P-0.007), HR for correcting the history of vertebral or hip fractures is 3.10 (95%CI, 1.33-7.24; P-0.009).
HR was 1.19 (95% CI, 1.04-1.36; P=0.009) when the average radiation dose of thoracic fractures increased by 5 gy on a single vertebrae.
study was the first to investigate the incidence of thoracic fractures in patients with stage I-III esophageal cancer after endoscopy, surgery, or CRT treatment.
study concluded that patients treated with CRT were more likely to have thoracic fractures than those treated with endoscopy or surgery.
the cumulative occurrence of vertebral fractures in the CRT group was consistent with previous reports of vertebral fractures after radiotherapy.
current analysis includes known risk factors for vertebral fractures and identifies CRT as an independent risk factor for thoracic fractures.
3-year cumulative vertebral fracture rate of 12.3% in the results of the study showed that vertebral fractures were not uncommon after CRT treated esophageal cancer in the chest.
pathophysiological mechanism of fractures caused by radiation therapy is similar to that of old-age osteoporosis.
is characterized by reduced bone formation mediated by osteoblasts, increased bone marrow fat, and apoptosis of bone cells.
these changes lead to deterioration of bone structure, loss of bone density, and eventually fractures of the vertebrae.
to reduce the risk of vertebral fractures, osteoporosis, such as vitamin D or calcium, can be treated in this population.
the automatic contour recognition system for low HU vertebrae and radiation therapy programmes to reduce radiation doses to these vertebrae will be future work.
(CT value) is a unit of measurement that measures the density of a local tissue or organ in the human body, commonly referred to as a Heinz unit (hounsfieldunit, HU) air of -1000 and dense bone of 1000.
) References: Fujii, K., Sakanaka, K., Uozumi, R., Ishida, Y., Inoo, H., Tsunoda, S., ... Mizowaki, T. (2020). Association of Chemoradiotherapy With Thoracic Vertebrals Fractures in Patients With Esophageal Cancer. JAMA Network Open, 3 (9), e2013952. doi:10.1001/jamanetworkopen.2020.13952liangying Source: MedSci Originals !-- Content Presentation Ends -- !-- To Determine If Login Ends.