Bliss et al. (85) reported the development of severe pelvic fractures in 5 patients out of 183 who had been treated with radical radiotherapy for carcinoma of the cervix. Two of these patients with fractures had underlying rheumatoid arthritis. In this report, the authors suggested that underlying connective tissue disorders or low bone mass increased the risk for radionecrosis following irradiation.

Tai et al. (86) also reported the incidence of pelvic fractures in 336 women treated for endometrial or vaginal cancer with irradiation. Sixteen of the 336 women developed symptomatic pelvic fractures with a median time of onset of 11 months. The 5-year incidence was 2.1%. Ofthe 16 fractures, 6 were initially misdiagnosed as metastatic lesions.

In a letter to the editor in Lancet, MirĂ³ and Orecchia (87) noted that the reports of pelvic insufficiency fractures in patients treated with irradiation for cancer raised the possibility of an interaction with bone that increases fracture risk. As noted by Bliss et al. (85), underlying low bone mass may increase this risk. If pelvic pain is erroneously assumed to be due to metastatic disease instead of radiation-induced fracture, particularly in the setting of low bone mass, inappropriate treatment could result with a further decline in the patient's quality of life (86).

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