Objective:

To update the incidence of radiation therapy-induced pelvic insufficiency fractures (PIF) and analyze influencing factors through a detailed subgroup analysis of various treatment modalities and patient characteristics.

Key Findings:

• The updated PIF rate was found to be higher than the previously reported 14%, with recent studies indicating rates of 28% and 32% from studies by Miyasaka and Wark, respectively.
• Subgroup analyses revealed significant associations between PIF occurrence and factors such as RT technique, dose, and patient characteristics like BMI and bone density.

Interpretation:

The findings suggest an increased incidence of PIF following radiation therapy in pelvic cancer patients, highlighting the need for improved risk assessment and management strategies.

Limitations:

• Potential publication bias due to the exclusion of non-cohort studies, which may lead to an underestimation of PIF rates.
• Variability in RT techniques and patient demographics across studies may affect the generalizability of the findings.

Conclusion:

This meta-analysis underscores the importance of monitoring PIF in pelvic cancer patients post-RT and suggests that advancements in RT techniques may significantly influence fracture rates, necessitating updated risk assessment and management strategies.