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.
Curè„us. 2016 Mar 06*** epublish ***
Alia M Daoud, Mack Hudson, Kenneth G Magnus, Fleur Huang, Brita L Danielson, Peter Venner, Ronak Saluja, Bronwen LeGuerrier, Helene Daly, Urban Emmenegger, Alysa Fairchild
Faculty of Medicine, Cross Cancer Institute, University of Alberta., Oncologic Imaging, Cross Cancer Institute, University of Alberta., Oncologic Imaging, Cross Cancer Institute, University of Alberta., Radiation Oncology, Cross Cancer Institute, University of Alberta., Department of Oncology, Cross Cancer Institute, University of Alberta., Medical Oncology, Cross Cancer Institute, University of Alberta., Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre., Palliative Radiation Oncology, Cross Cancer Institute, University of Alberta., Radiation Therapy, Cross Cancer Institute, University of Alberta., Odette Cancer Centre, Sunnybrook Health Sciences Centre., Radiation Oncology, Cross Cancer Institute, University of Alberta.