Introduction and Objective:
Locally advanced rectal cancers witha high risk of recurrence need multimodal treatment Rusing neoadiuvant preoperative chemoradiotherapy or preoperative radiotherapy. Both rectal cancer surgery and the additional chemoradiotherapy or radiotherapy may cause late sequelae. The aim of the study is to present a clinical situation in which a pelvic recurrence of rectal cancer has to be distinguished from therapy side effects. Insufficiency fracture (IF) is one of the therapy side-effects. It can cause pain and decrease mobility and it is a well-known late complication to pelvic radiotherapy, but can be misinterpreted as a local recurrence.

It is extremely important to distinguish IF from metastases, which may require biopsies and initiation of potentially toxic treatments such as chemotherapy. MRI and CT scans are complementary modalities to make an accurate diagnosis of IF.

Pikuła A, Pikuła TS, Pastuszak M. Sacral insufficiency fracture following rectal cancer treatment – Case study. J Pre-Clin Clin Res. 2020; 14(4): 120–122. doi: 10.26444/jpccr/128136
Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol. 2017; 28: iv22–iv40.
Junginger T, Goenner U, Hitzler M, et al. Long-term oncologic outcome after transanal endoscopic microsurgery for rectal carcinoma. Dis Colon Rectum. 2016; 59: 8–15.
Stornes T, Wibe A, Nesbakken A, et al. National early rectal cancer treatment revisited. Dis Colon Rectum. 2016; 59: 623–629.
Kronborg C,Jørgensen Petersen J, Jensen L, et al. Pelvic insufficiency fractures, dose volume parameters and plan optimization after radiotherapy for rectal cancer. Clin Transl Radiat Oncol. 2019 Sep 10; 19: 72–76.
Ikoma N, You YN, Bednarski BK, et al. Impact of Recurrence and Salvage Surgery on Survival After Multidisciplinary Treatment of Rectal Cancer. J Clin Oncol. 2017; 35: 2631.
Kang Y, Chao T, Wang T, et al. Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study. Cancer Med. 2019 Jul; 8(8): 3639–364.
7. O’Connor T, Cole P. Pelvic Insufficiency Fractures Geriatr Orthop Surg Rehabil. 2014 Dec; 5(4): 178–90.
Zhong X, Li J, Zhang L, et al. Characterization of Insufficiency Fracture and Bone Metastasis After Radiotherapy in Patients With Cervical Cancer Detected by Bone Scan: Role of Magnetic Resonance Imaging.Front Oncol. 9: 183. https://w w
Bazire L, Xu H, MD, Foy JH, Amessis M, Malhair C, et al. Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature Br J Radiol. May 2017; 90(1073): 20160885.
Journals System - logo
Scroll to top