Limits...
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

Plain x-rays.5A: Abdominal plain film (August 11, 2011) demonstrating normal hip joints. 5B: Pelvis plain film (Nov 22, 2011) revealing flattening of the superior articular surface of the left femoral head accompanied by mild juxtaarticular sclerosis and small juxtaarticular cysts (arrow) in keeping with early avascular necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4829398&req=5

FIG5: Plain x-rays.5A: Abdominal plain film (August 11, 2011) demonstrating normal hip joints. 5B: Pelvis plain film (Nov 22, 2011) revealing flattening of the superior articular surface of the left femoral head accompanied by mild juxtaarticular sclerosis and small juxtaarticular cysts (arrow) in keeping with early avascular necrosis.

Mentions: Plain films conducted three weeks later demonstrated slight flattening of the superior articular surface of the left proximal femoral head, accompanied by mild juxtaarticular sclerosis and cysts, in keeping with early AVN. In retrospect, these changes could be identified on the August imaging (Figure 5).


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)

Plain x-rays.5A: Abdominal plain film (August 11, 2011) demonstrating normal hip joints. 5B: Pelvis plain film (Nov 22, 2011) revealing flattening of the superior articular surface of the left femoral head accompanied by mild juxtaarticular sclerosis and small juxtaarticular cysts (arrow) in keeping with early avascular necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG5: Plain x-rays.5A: Abdominal plain film (August 11, 2011) demonstrating normal hip joints. 5B: Pelvis plain film (Nov 22, 2011) revealing flattening of the superior articular surface of the left femoral head accompanied by mild juxtaarticular sclerosis and small juxtaarticular cysts (arrow) in keeping with early avascular necrosis.
Mentions: Plain films conducted three weeks later demonstrated slight flattening of the superior articular surface of the left proximal femoral head, accompanied by mild juxtaarticular sclerosis and cysts, in keeping with early AVN. In retrospect, these changes could be identified on the August imaging (Figure 5).

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