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Impact of three-dimensional chemoradiation on pelvic bone mineral density, low back pain, and disability in cervical cancer: a prospective study
  1. Divyesh Kumar1,
  2. Raviteja Miriyala1,
  3. Bhavana Rai1,
  4. Pooja Bansal2,
  5. Arun S Oinam1,
  6. Tulika Singh3 and
  7. Sushmita Ghoshal1
  1. 1 Radiotherapy and Oncology, PGIMER, Chandigarh, India
  2. 2 Biostatistics, PGIMER, Chandigarh, India
  3. 3 Radiodiagnosis, PGIMER, Chandigarh, India
  1. Correspondence to Dr Divyesh Kumar, Radiotherapy and Oncology, PGIMER, Chandigarh 160012, India; divyeshanand1{at}


Objective To prospectively analyze the effect of three-dimensional chemoradiation on the bone mineral density of pelvic bones and its association with low back pain and disability in patients with locally advanced cervical cancer.

Methods In biopsy proven locally advanced cervical cancer patients, bone mineral density and T scores for lumbar vertebrae 5, dorsal thoracic vertebrae 12, and T scores for the femoral neck were analyzed. Low back pain was scored using the visual analog scale while disability scoring was done using the Oswestry low back pain disability scale. Furthermore, a subgroup analysis for patients (classified according to menopausal status) was performed.

Results In total, 106 patients were analyzed. A statistically significant decline in mean bone mineral density was observed at all three sites (vertebrae 5 and 12, and the femoral neck) post-chemoradiation therapy compared with pretreatment bone mineral density (0.671 vs 0.828, −2.083 vs −1.531, −2.503 vs −1.626; all p<0.001). Similarly, in subgroup analyses, at all three sites, pre-menopausal patients showed a statistically significant association (0.876 vs 0.697, −1.203 vs −0.2.761, –1.403 vs −2.232; all p<0.001) while a non-significant association was observed for post-menopausal patients at vertebrae 12 (−1.707 vs −1.719; p=0.09) with a statistically significant association at vertebrae 5 and the femoral neck (0.803 vs 0.656, –1.746 vs −2.648; p<0.01). Although statistically significant low back pain and disability scores were observed overall and irrespective of menopausal status, no correlation between bone mineral density and low back pain and disability was observed.

Conclusion Pelvic bone mineral density decreases significantly after chemoradiation, irrespective of menopausal status. However, no correlation with low back pain and disability was observed. Pelvic bone mineral density analysis should be considered before chemoradiation in cervical cancer.

  • cervical cancer
  • radiotherapy
  • pelvis

Data availability statement

Data not available due to confidential patient information.

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Data availability statement

Data not available due to confidential patient information.

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  • Contributors Study design, writing: DK and RM. Data analysis: DK, PB, BR, TS, and ASO. Data collection, review, and editing: DK, BR, SG, and ASO.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.