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Avascular Necrosis of the Femoral Head After Palliative Radiotherapy in Metastatic Prostate Cancer: Absence of a Dose Threshold?

Daoud AM, Hudson M, Magnus KG, Huang F, Danielson BL, Venner P, Saluja R, LeGuerrier B, Daly H, Emmenegger U, Fairchild A - Cureus (2016)

Bottom Line: In this case report, we describe a patient with prostate cancer metastatic to bone diagnosed with AVN after receiving single-fraction palliative RT to the left femoral head.At present, the RT dose threshold below which there is no risk for AVN is unknown, and therefore detrimental impact from the RT cannot be excluded.Given the possibility that RT-induced AVN is a stochastic effect, it is important to be aware of the possibility of this diagnosis in any patient with a painful hip who has received RT to the femoral head.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, Cross Cancer Institute, University of Alberta.

ABSTRACT
Avascular necrosis (AVN) is the final common pathway resulting from insufficient blood supply to bone, commonly the femoral head. There are many postulated etiologies of non-traumatic AVN, including corticosteroids, bisphosphonates, and radiotherapy (RT). However, it is unclear whether there is a dose threshold for the development of RT-induced AVN. In this case report, we describe a patient with prostate cancer metastatic to bone diagnosed with AVN after receiving single-fraction palliative RT to the left femoral head. Potential contributing factors are discussed, along with a review of other reported cases. At present, the RT dose threshold below which there is no risk for AVN is unknown, and therefore detrimental impact from the RT cannot be excluded. Given the possibility that RT-induced AVN is a stochastic effect, it is important to be aware of the possibility of this diagnosis in any patient with a painful hip who has received RT to the femoral head.

No MeSH data available.


Related in: MedlinePlus

PSA values over time.Given the absolute values, it is likely that the patient’s aggressive prostate cancer was non-PSA-secreting.
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FIG1: PSA values over time.Given the absolute values, it is likely that the patient’s aggressive prostate cancer was non-PSA-secreting.

Mentions: By early 1997, he had experienced an asymptomatic biochemical recurrence. Restaging transrectal ultrasound (TRUS), computed tomography (CT), and bone scan were negative. A salvage prostate bed RT was recommended but declined by the patient, so he was started on diethylstilbestrol 0.1 mg od and megestrol 40 mg TID. These were discontinued within six months due to fatigue and depression in favour of watchful waiting. Further imaging between 1998 and 2001 did not reveal evidence of bone metastases despite further biochemical progression (Figure 1). During this time, he participated in a clinical trial briefly (<6 months) but was withdrawn due to non-compliance in early 2002. Ultimately, he agreed to intermittent cyproterone, acknowledging that it was not standard of care at the time.


Avascular Necrosis of the Femoral Head After Palliative Radiotherapy in Metastatic Prostate Cancer: Absence of a Dose Threshold?

Daoud AM, Hudson M, Magnus KG, Huang F, Danielson BL, Venner P, Saluja R, LeGuerrier B, Daly H, Emmenegger U, Fairchild A - Cureus (2016)

PSA values over time.Given the absolute values, it is likely that the patient’s aggressive prostate cancer was non-PSA-secreting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4829398&req=5

FIG1: PSA values over time.Given the absolute values, it is likely that the patient’s aggressive prostate cancer was non-PSA-secreting.
Mentions: By early 1997, he had experienced an asymptomatic biochemical recurrence. Restaging transrectal ultrasound (TRUS), computed tomography (CT), and bone scan were negative. A salvage prostate bed RT was recommended but declined by the patient, so he was started on diethylstilbestrol 0.1 mg od and megestrol 40 mg TID. These were discontinued within six months due to fatigue and depression in favour of watchful waiting. Further imaging between 1998 and 2001 did not reveal evidence of bone metastases despite further biochemical progression (Figure 1). During this time, he participated in a clinical trial briefly (<6 months) but was withdrawn due to non-compliance in early 2002. Ultimately, he agreed to intermittent cyproterone, acknowledging that it was not standard of care at the time.

Bottom Line: In this case report, we describe a patient with prostate cancer metastatic to bone diagnosed with AVN after receiving single-fraction palliative RT to the left femoral head.At present, the RT dose threshold below which there is no risk for AVN is unknown, and therefore detrimental impact from the RT cannot be excluded.Given the possibility that RT-induced AVN is a stochastic effect, it is important to be aware of the possibility of this diagnosis in any patient with a painful hip who has received RT to the femoral head.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, Cross Cancer Institute, University of Alberta.

ABSTRACT
Avascular necrosis (AVN) is the final common pathway resulting from insufficient blood supply to bone, commonly the femoral head. There are many postulated etiologies of non-traumatic AVN, including corticosteroids, bisphosphonates, and radiotherapy (RT). However, it is unclear whether there is a dose threshold for the development of RT-induced AVN. In this case report, we describe a patient with prostate cancer metastatic to bone diagnosed with AVN after receiving single-fraction palliative RT to the left femoral head. Potential contributing factors are discussed, along with a review of other reported cases. At present, the RT dose threshold below which there is no risk for AVN is unknown, and therefore detrimental impact from the RT cannot be excluded. Given the possibility that RT-induced AVN is a stochastic effect, it is important to be aware of the possibility of this diagnosis in any patient with a painful hip who has received RT to the femoral head.

No MeSH data available.


Related in: MedlinePlus