S446
Clinical - Gynaecological
ESTRO 2026
after different treatment modality: a systematic review. Medicina (Kaunas) 2022; 58:1223. doi: 10.3390/medicina58091223. 3.Shi Y, Cai J, Wu Z, et al. Effects of a nurse-led positive psychology intervention on sexual function, depression and subjective well-being in postoperative patients with early-stage cervical cancer: A randomized controlled trial. Int J Nurs Stud. 2020 Nov;111:103768. doi:10.1016/j.ijnurstu.2020.103768 Keywords: cervical cancer, sexual functions, distress Poster Discussion 2196 Quantification of vertebral dose-response and bone preservation in pelvic radiotherapy: prospective evidence from RadBone randomised controlled trial Artemis Bouzaki 1 , Viktoria Chatzimavridou- Grigoriadou 1,2 , Alan McWilliam 1 , Claire Higham 2,1 , Azadeh Abravan 1,3 1 Cancer Sciences, University of Manchester, Manchester, United Kingdom. 2 Endocrine Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom. 3 Institute of genetics and cancer, University of Edingburgh, Edinburgh, United Kingdom Purpose/Objective: Radiotherapy-related insufficiency fractures are a significant morbidity in cancer survivors, yet the dose-response relationship between radiation exposure and bone mineral density (BMD) loss remains undefined. Current clinical practice lacks evidence-based bone health guidance because prospective studies quantifying longitudinal dual-energy X-ray absorptiometry (DXA)-derived BMD outcomes are rare. RadBone (Trial number NCT04555317) is the first prospective randomised trial to examine the dose relationship for radiation-induced bone loss and assess the feasibility of a musculoskeletal health package (MHP) after
pelvic radiotherapy. Material/Methods: 32 female patients undergoing pelvic radiotherapy for gynaecological or anorectal malignancies were prospectively enrolled. A randomised subgroup received the MHP intervention consisting of prehabilitation exercise, calcium, and vitamin D supplementation. Lumbar vertebrae (L1-L4) were segmented from planning CT using LIMBUS V1.8.1, and D50 was collected for each vertebra. Segmentation quality was visually inspected. D50 for out-of-field vertebra was imputed via multiple imputation and converted to biologically effective dose(BED; = 2 Gy). Baseline and 18-month DXA provided L1-L4 BMD measurements.Patients were stratified into high-(D50 BED > 5 Gy, n=27 vertebra over 15 patients) and low-dose groups (BED ≤ 5 Gy, n=77 vertebra over 24 patients). Mixed- effects linear regression, adjusted for age and menopausal status, assessed the relationship between D50 BED and percentage change in BMD in the full cohort and high-dose subgroup. The full cohort model included additional adjustment for baseline BMD and vertebra location. Model assumptions were verified by residual diagnostics. Secondary analyses examined the MHP effect on both full cohort and high dose models. Results: Six patients were excluded (3 had no vertebrae in the radiation field of view; 3 received bisphosphonate therapy), leaving 26 for analysis. Median age was 58 years (range 41–76); 62% were postmenopausal. Cancer diagnoses included: cervical n=9, endometrial n=13 and anorectal n=4. Median percentage change in BMD ( ): -3.3% (IQR: -7.3 - 1.5).In the full cohort analysis, no overall dose-response relationship was detected. However, within the high-dose subgroup, a significant linear relationship emerged ( β = – 0.2% per Gy, p < 0.001, Figure 1).Patients receiving the MHP intervention (n = 11)
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