Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지

Two Cases of Avascular Necrosis of the Femur Head after Whole Pelvic Radiation Therapy for the Treatment of Cervical Cancer

자궁경부암의 전골반방사선치료 후 발생한 대퇴골두 무혈성괴사 2예

  • Yu, Jeong-Il (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung-Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Dong-Ryul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung-Ae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 유정일 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 허승재 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 박원 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 오동렬 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 이정애 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실)
  • Published : 2008.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Avascular necrosis(AVN) is a disease characterized by the temporary or permanent loss of the blood supply to the bones, resulting from many possible causes, including radiation therapy. The femoral head is known to be the most common site of AVN. The authors encountered two cases of AVN of the femoral head among 557 patients with cervical cancer treated with whole pelvic radiation therapy at the Samsung Medical Center. AVN of the femoral head was presented with a sclerotic density change in a plain roentgenography and a decreased signal intensity lesion on the T1 and T2 weighted phases of a magnetic resonance image(MRI). Although it is a very rare complication after whole pelvic radiation therapy, AVN of the femoral head should be considered when characteristic imaging findings appear on follow-up examinations.

대퇴골두 무혈성괴사는 혈류장애로 인해 대퇴골두의 골세포 괴사가 나타나는 것으로 여러 원인 중 방사선치료도 하나의 원인으로 알려져 있으나 발병률에 대해서는 보고된 바 없는 상태이다. 저자들은 삼성서울병원에서 전골반 방사선치료를 받은 자궁암환자 577명 중 2명의 환자에서 대퇴골두 무혈성괴사를 경험하였다. 2예 모두 전형적인 방사선학적 소견을 보였다. 골반 방사선치료 후 발생하는 대퇴골두 무혈성괴사는 매우 드물게 나타나지만 방사선 조사 범위에 국한된 특징적인 영상의학적 소견을 보이므로 진단에 유념해야 하겠다.

Keywords

References

  1. DiGiovanni CW, Patel A, Calfee R, Nickisch F. Osteonecrosis in the foot. J Am Acad Orthop Surg 2007; 15:208-217 https://doi.org/10.5435/00124635-200704000-00004
  2. Abbas AA, Yoon TR, Lee JH, Hur CI. Posttraumatic avascular necrosis of the femoral head in teenagers treated by a modified transtrochanteric rotational osteotomy: a report of three cases. J Orthop Trauma 2008;22:63-69 https://doi.org/10.1097/BOT.0b013e31815aba30
  3. Tani N, Oka S, Hayakawa S, Kitabayashi Y, Fukui K. [A case report of male alcoholics treated the left replacement prosthesis on account of the idiopathic avascular necrosis of the left femoral head]. Nihon Arukoru Yakubutsu Igakkai Zasshi 1999;34:173-182
  4. Bekler H, Uygur AM, Gokce A, Beyzadeoglu T. The effect of steroid use on the pathogenesis of avascular necrosis of the femoral head: an animal model. Acta Orthop Traumatol Turc 2007;41:58-63
  5. Orban H, Cirstoiu C, Adam R. Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis. Rom J Intern Med 2007;45:123-129
  6. Hughes C, Patterson K, Murray M. Avascular necrosis of the femoral head in childhood chronic myeloid leukaemia. Br J Haematol 2007;139:1 https://doi.org/10.1111/j.1365-2141.2007.06727.x
  7. Dhadda AS, Chan S. Bilateral avascular necrosis of the hips after chemoradiotherapy for cervical cancer. Clin Oncol (R Coll Radiol) 2006;18:576-577 https://doi.org/10.1016/j.clon.2006.05.008
  8. Prosnitz LR, Lawson JP, Friedlaender GE, Farber LR, Pezzimenti JF. Avascular necrosis of bone in Hodgkin's disease patients treated with combined modality therapy. Cancer 1981;47:2793-2797 https://doi.org/10.1002/1097-0142(19810615)47:12<2793::AID-CNCR2820471206>3.0.CO;2-A
  9. Ihn JC, Kim SY, Oh CW, Kim YG. Osteonecrosis of the femoral head and acetabulum following radiation therapy: difficult case in diagnosis and treatment. J Korean Orthop Assoc 1998;33:5
  10. Epps HR, Brinker MR, O'Connor DP. Bilateral femoral neck fractures after pelvic irradiation. Am J Orthop 2004;33: 457-460; discussion 460
  11. Kerachian MA, Harvey EJ, Cournoyer D, Chow TY, Seguin C. Avascular necrosis of the femoral head: vascular hypotheses. Endothelium 2006;13:237-244 https://doi.org/10.1080/10623320600904211
  12. Freund E. Zur Frage der aseptischen Knochennekrose Virchow. Arch Path Anat 1926;261:287-314 https://doi.org/10.1007/BF01891880
  13. Jereczek-Fossa BA, Orecchia R. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 2002;28: 65-74 https://doi.org/10.1053/ctrv.2002.0254
  14. Costantino PD, Friedman CD, Steinberg MJ. Irradiated bone and its management. Otolaryngol Clin North Am 1995; 28:1021-1038
  15. Ikushima H, Osaki K, Furutani S, et al. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol 2006;103:1100-1104 https://doi.org/10.1016/j.ygyno.2006.06.038
  16. Grigsby PW, Roberts HL, Perez CA. Femoral neck fracture following groin irradiation. Int J Radiat Oncol Biol Phys 1995;32:63-67 https://doi.org/10.1016/0360-3016(95)00546-B
  17. Guise TA. Bone loss and fracture risk associated with cancer therapy. Oncologist 2006;11:1121-1131 https://doi.org/10.1634/theoncologist.11-10-1121
  18. Bluemke DA, Zerhouni EA. MRI of avascular necrosis of bone. Top Magn Reson Imaging 1996;8:231-246 https://doi.org/10.1097/00002142-199608000-00003
  19. Bowlus RA, Armbrust LJ, Biller DS, Hoskinson JJ, Kuroki K, Mosier DA. Magnetic resonance imaging of the femoral head of normal dogs and dogs with avascular necrosis. Vet Radiol Ultrasound 2008;49:7-12 https://doi.org/10.1111/j.1740-8261.2007.00309.x
  20. Lee JA, Huh SJ, Oh D, Bae DS. Osteoradionecrosis after three-dimensional conformal radiotherapy for recurrent cervical cancer presenting as a progressive osteolytic lesion. Ann Nucl Med 2008;22:139-141 https://doi.org/10.1007/s12149-007-0090-3
  21. Oh D, Huh SJ, Nam H, et al. Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: analysis of risk factors. Int J Radiat Oncol Biol Phys 2008;70:1183-1188 https://doi.org/10.1016/j.ijrobp.2007.08.005