Abstract
Background
Spontaneous rib fractures (SRFs) are defined as fractures without apparent blunt force
trauma. This study evaluated the incidence and risk factors of SRFs after treatment
of patients with breast cancer based on bone scans. In addition, we analyzed radiation-associated
SRFs and identified radiotherapy (RT) factors related to SRF.
Patients and Methods
We retrospectively reviewed 1265 patients with breast cancer who underwent surgery
in 2015 at our institution, and were followed-up with at least 3 bone scans. Bone
scans were conducted approximately every 12 months after breast cancer treatment.
The endpoint was SRF detected by bone scan. In this study, 754 (60%) patients were
treated with chemotherapy, 867 (69%) with RT, and 946 (75%) with anti-hormone therapy.
Results
The median follow-up duration was 37.5 months. A total of 209 (16.5%) patients experienced
SRFs during follow-up. The incidence of SRFs increased sharply during the 3-year follow-up
period after completion of treatment. In multivariate analyses, abnormal bone density,
chemotherapy, and RT were significant risk factors for SRFs. In patients treated with
RT (n = 867), 159 (18%) rib fractures occurred: 127 (80%) in the ipsilateral breast
and 32 (20%) in the contralateral breast. Among the patients with ipsilateral SRFs
who received tumor bed boost (n = 84), the SRF occurred inside the boost field in
80 (95%) cases. Multivariate analysis of RT subgroups showed that hypofractionated
RT increased the rate of SRFs (P = .002).
Conclusions
Most of the rib fractures that occurred after treatment were spontaneous. Hypofractionated
RT increased the risk of ipsilateral rib fractures in RT-treated patients.
Keywords
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Article info
Publication history
Published online: July 23, 2020
Accepted:
July 20,
2020
Received in revised form:
July 2,
2020
Received:
March 11,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
