Osteoradionecrosis after three-dimensional conformal radiotherapy for recurrent cervical cancer presenting as a progressive osteolytic lesion.
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.
Lee
Jung A
JA
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
Huh
Seung J
SJ
Oh
Dongryul
D
Bae
Duk S
DS
D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007044:Hysterectomy; D007085:Ilium / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D010014:Osteolysis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D049268:Positron-Emission Tomography; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D016879:Salvage Therapy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D051598:Whole Body Imaging
D019788:Fluorodeoxyglucose F18