Osteoradionecrosis of the Ribs following Breast Radiotherapy

Case Reports in Oncology
Luke NichollsJennifer Harvey

Abstract

Osteoradionecrosis (ORN) of the chest wall is a rare complication after whole-breast radiotherapy (RT). Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU) requirements. Eleven months after RT, the patient developed right lateral chest wall pain, with magnetic resonance imaging (MRI) demonstrating two fractures involving the underlying right fifth and sixth ribs associated with fatty marrow changes in the second to sixth ribs, thus raising the possibility of ORN. Treatments including hyperbaric oxygen, pentoxifylline and vitamin E were used with symptomatic improvements. There was demonstrable resolution on follow-up MRI at 2.5 years. The incidence of ORN utilising modern RT techniques and standard fractionatio...Continue Reading

Citations

Jun 3, 2016·The Breast : Official Journal of the European Society of Mastology·Orit Kaidar-PersonLawrence B Marks
Apr 12, 2016·Oral Diseases·P CeponisJ J Freiberger
Mar 12, 2019·Annals of Plastic Surgery·Paige L MyersAshley N Amalfi

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