Abstract
Osteoradionecrosis (ORN) of the pelvic bone presenting as a progressive osteolytic lesion, following three-dimensional conformal radiotherapy (3DCRT) with concurrent chemotherapy, is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. We report on a case with an unusual presentation of ORN mimicking bony metastasis that should be taken note of by physicians. A 46-year-old woman who had recurrent cervical cancer in the right pelvic sidewall underwent concurrent salvage chemoradiotherapy. She received 63 Gy 3DCRT. At 22 months, post-RT, an asymptomatic but enlarging osseous defect in the right ilium, located within the area covered by a 95% isodose line, was demonstrated on pelvic computed tomography (CT). ORN was confirmed by whole-body [18F] fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET) CT scan and CT-guided bone biopsy. A localized, growing ORN of pelvic bone after high-dose 3DCRT is an uncommon late complication. Differential diagnosis between ORN and bony metastasis may be possible with low FDG uptake of ORN on PET-CT scans.
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References
Huh SJ, Kim B, Kang MK, Lee JE, Lim DH, Park W, et al. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol 2002;86:264–268.
Huh SJ, Kang MK, Han Y. Small bowel displacement system-assisted intensity-modulated radiotherapy for cervical cancer. Gynecol Oncol 2004;93:400–406.
Feltl D, Vosmik M, Jirasek M, Stahalova V, Kubes J. Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies-result of a long-term follow-up. Int J Gynecol Cancer 2006;16:478–483.
Wong JK, Wood RE, McLean M. Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:16–21.
Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109–122.
Rowe LJ, Yochum TR. Hematologic and vascular disorders. In: Yochum TR, Rowe LJ, editors. Essentials of skeletal radiology. 2nd ed. Baltimore: Williams and Wilkins; 1996. p. 1243–326.
Liu SH, Chang JT, Ng SH, Chan SC, Yen TC. False positive fluorine-18 fluorodeoxy-d-glucose positron emission tomography finding caused by osteoradionecrosis in a nasopharyngeal carcinoma patient. Br J Radiol 2004;77:257–260.
Hung GU, Tsai SC, Lin WY. Extraordinarily high F-18 FDG uptake caused by radiation necrosis in a patient with nasopharyngeal carcinoma. Clin Nucl Med 2005;30:558–559.
Bui QC, Lieber M, Withers HR, Corson K, van Rijnsoever M, Elsaleh H. The efficacy of hyperbaric oxygen therapy in the treatment of radiation-induced late side effects. Int J Radiat Oncol Biol Phys 2004;60:871–878.
Lujan AE, Mundt AJ, Yamada SD, Rotmensch J, Roeske JC. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2003;57:516–521.
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Lee, J.A., Huh, S.J., Oh, D. et al. Osteoradionecrosis after three-dimensional conformal radiotherapy for recurrent cervical cancer presenting as a progressive osteolytic lesion. Ann Nucl Med 22, 139–141 (2008). https://doi.org/10.1007/s12149-007-0090-3
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DOI: https://doi.org/10.1007/s12149-007-0090-3