Journal
EJSO
Volume 48, Issue 12, Pages 2509-2517Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2022.06.028
Keywords
Rectal cancer treatment; Sclerostin; Carboxy-terminal cross-linking telopeptide; of type I collagen (CTX); Bone-specific alkaline phosphatase (BALP); Amino-terminal propeptide of type I; procollagen (PINP); Pelvicinsufficiency fractures
Funding
- Swedish Cancer Society
- Stockholm Cancer Society
- Bengt Ihre Research Fellowship
- Bengt Ihre Foundation
- Stockholm County Council
- Karolinska Institutet
- Region Ostergotland
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This study investigated the association between pelvic radiotherapy (RT) and changes in serum bone biomarkers in women with rectal cancer. The results showed that preoperative RT was associated with an increase in the formation marker PINP. Additionally, radiation-induced bone injuries were detected in some participants, which were associated with higher levels of BALP.
Introduction: Pelvic radiotherapy (RT) increases the risk of pelvic insufficiency fractures. The aim was to investigate if RT is associated with changes in serum bone biomarkers in women with rectal cancer, and to examine the incidence of radiation-induced bone injuries and the association with bone biomarkers.Material and methods: Women diagnosed with rectal cancer stage I-III, planned for abdominal surgery +/- preoperative (chemo) RT, were prospectively included and followed one year. Serum bone biomarkers comprised sclerostin (regulatory of bone formation), CTX (resorption), BALP and PINP (for-mation). A subgroup was investigated with annual pelvic magnetic resonance imaging (MRI). The as-sociation between RT and bone biomarkers was explored in regression models.Results: Of 134 included women, 104 had surgery with preoperative RT. The formation markers BALP and PINP increased from baseline to one year in the RT-exposed group (p < 0.001, longitudinal comparison). In the adjusted regression analysis, the mean increase in PINP was higher in the RT-exposed than the unexposed group (17.6 (3.6-31.5) mg/L, p = 0.013). Sclerostin and CTX did not change within groups nor differed between groups. Radiation-induced injuries were detected in 16 (42%) of 38 women with available MRI. At one year, BALP was higher among women with than without bone injuries (p = 0.018, cross-sectional comparison).Conclusions: Preoperative RT was associated with an increase in the formation marker PINP, which could represent bone recovery following RT-induced injuries, commonly observed in participants evaluated with MRI. These findings should be further explored in larger prospective studies on bone health in rectal cancer patients.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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