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Relative Importance of Hip and Sacral Pain Among Long-Term Gynecological Cancer Survivors Treated with Pelvic Radiotherapy and Their Relationships to Mean Absorbed Doses.

Journal article
Authors Ann-Charlotte Waldenström
Caroline Olsson
Ulrica Wilderäng
Gail Dunberger
Helena Lindholm Schulz
Eleftheria Alevronta
Massoud Al-Abany
Susan Tucker
Elisabeth Avall-Lundqvist
Karl-Axel Johansson
Gunnar Steineck
Published in International Journal of Radiation Oncology, Biology, Physics
Volume 84
Issue 2
Pages 428–436
ISSN 1879-355X
Publication year 2012
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Oncology
Pages 428–436
Language en
Subject categories Radiological physics


PURPOSE: To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs. METHODS AND MATERIALS: We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors. RESULTS: Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy. CONCLUSIONS: Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.

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