Osteoradionecrosis of the ribs following breast radiotherapy

Nicholls, Luke, Gorayski, Peter and Harvey, Jennifer (2015) Osteoradionecrosis of the ribs following breast radiotherapy. Case Reports in Oncology, 8 2: 332-338. doi:10.1159/000438786

Author Nicholls, Luke
Gorayski, Peter
Harvey, Jennifer
Title Osteoradionecrosis of the ribs following breast radiotherapy
Journal name Case Reports in Oncology   Check publisher's open access policy
ISSN 1662-6575
Publication date 2015-08-06
Year available 2015
Sub-type Article (original research)
DOI 10.1159/000438786
Open Access Status DOI
Volume 8
Issue 2
Start page 332
End page 338
Total pages 7
Place of publication Basel, Switzerland
Publisher S. Karger AG
Collection year 2016
Language eng
Formatted abstract
Introduction: 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.

Case Report: 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.

Conclusion: The incidence of ORN utilising modern RT techniques and standard fractionation is rare. Numerous treatments are available, with variable response rates. Emerging evidence of predictive gene profiling to estimate the risk of radiation sensitivity may assist in individualising preventative strategies to mitigate the risk of ORN.
Keyword Breast radiotherapy
Rib fracture
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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