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Dose-volume constraints for IMRT:
pelvic bone + plexus
Baxter et al:
Increased risk of pelvic fractures in elderly women
Holm et al (follow-up data Stockholm trials):
5.3% femoral neck/pelvic fractures + hospitalization (vs 2.4% no RT)
No reports on dose-response relationship:
max 45-50 Gy
Sacral insufficiency fractures:
Rare but significant morbidity
Incidence: 3-7%
Independent risk factors: osteoporosis, female gender, age > 60 years
No data on dose-response relationship
Lumbosacral plexus:
Tunio et al (cervical cancer) 8% grade 2 or more plexopathy
Prospective studies in rectal cancer are warranted
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