How do you manage osteonecrosis and pelvic insufficiency fractures after pelvic radiotherapy?

I have never seen osteoradionecrosis happen before in the pelvis. It should not happen in the range of doses that are tolerable in the pelvis due to the constraints imposed by the sacral plexus and the luminal GI organs.

Sacral insufficiency fractures happen uncommonly, but are more common in female...

PIF incidence varies based on gender, age, imaging used, and malignancy treated with the highest incidence in post-menopausal women treated for endometrial cancer. Razavian et al., PMID 32442476.
Higher sacral dose increases risk and looks like conformity with IMRT reduces the risk.

Mir et al., PMID ...

I’m having difficulty envisioning this complication after RT doses for GI malignancies.