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Volume 16, Number 5, 2011

Radiotherapy induced hip joint avascular necrosis—Two cases report

Łukasz Michalecki, Dorota Gabryś, Roland Kulik, Jerzy Wydmański, Krystyna Trela


Background: Avascular necrosis (AVN) refers to the death of osteocytes and osteoblasts. Sites
such as the femoral head, the head of the humerus and the mandibula with restricted access
to local blood supply are particularly vulnerable to osteonecrosis.
A combination of several factors is responsible for ischaemia and is associated with AVN:
corticosteroids, alcohol abuse, Cushing’s syndrome, SLE, systemic vasculitis, RA, scleroderma,
haemoglobinopathies, radiotherapy. Management is based on proper diagnosis and
treatment – conservative, pharmacological or surgical.
Radiotherapy has become an integral part of the therapeutic programme of cancer
patients. However, early and late after-effects of irradiation still constitute a significant issue
in clinical practice.
Aim: The aim of this report is to present two cases of acetabular protrusion and femoral
head deformities after a therapeutic pelvic irradiation and draw physicians’ attention to
that clinical problem which continues to be underestimated.
Materials and methods: This report documents two cases of acetabular protrusion and femoral
head deformities after a therapeutic pelvic radiation.
Results: Avascular necrosis (AVN) constitutes a severe and challenging long-term complication
in radiation oncology.
Conclusion: It is necessary to take into account bone structures among organ at risk (OAR)
involved in irradiation fields. The detailed analysis of the dose distribution and the use of
collimators allow to decrease the total dose to OAR.
An adequate management, early diagnosis and prompt, proper treatment may protect
patients from long-term morbidities.

Signature: Rep Pract Oncol Radiother, 2011; 16(5) : 198-201

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