Guidelines for Complications of Cancer Treatment Vol VIII Part B

increased with concurrent administration of chemotherapeuticdrugs like, cisplatin, vincristine and adriamycin.Pelvic Insufficiency Stress Fractures (PIF’s) : PIF are animportant complication of pelvic RT which commonly occurswith normal stress in bones with diminished elastic flexibility.Commonly affects bones like neck of femur, vertebrae andpelvic bones. Majority of the patients are asymptomatic whilefew may report pain aggravated on motion. Less aggressivediagnostic studies reveal an incidence of PIF in 2-30% ofirradiated bones, while the more sophisticated MRI hasrevealed an incidence as high as 89%. Majority of the patientsimprove symptomatically with conservative management.Lumbosacral plexopathy: This entity has been occasionallyreported in patients with pelvic tumors treated to doses above60 - 67.5Gy. Characteristically, patients will present with lowermotor neuron weakness of legs along with musclefasciculations and loss of deep tendon reflexes.Premature menopause: Pelvic RT results in iatrogenicpremature menopause wherein the ovaries undergo atresia,and hormone production ceases. Ovarian hormones play asignificant role in the maintenance of bone mineralization,integrity of the cardiovascular system, libido, maturation andmaintenance of the breasts and vagina.Strategies to reduce complicationsWith the emergence of advanced technologies, newer strategiesto improve the therapeutic ratio, such that the effect on thetumor may be increased with subsequent decrease in thecomplication rates has become the dictum and the main drivingforce of modern Radiation Oncology. This goal is applicablein the treatment of every possible site of the human body. Thisgoal can be achieved by two principal methods: a) Physicalmethod, by use of sophisticated 3DCRT (3D conformal275