摘要放疗(radiation therapy,RT)是恶性骨肿瘤的有效治疗方法之一,目前已有的多项大样本、多中心的随机临床试验,均证实了放疗能显著降低恶性骨肿瘤术后的局部复发率,改善患者总生存率。但是,随着其应用的日益广泛,人们在注重疗效的同时,也更加关注放疗所导致的不良反应。放射性骨损伤(radiation bone injure,RBI)是指骨组织在接受射线照射后出现(临床发现)骨损伤,一般表现为迟发性损伤,平均2.4~10.0年,其病理改变包括骨萎缩、不全骨折及骨坏死。该病临床表现及影像学检查缺乏特异性,对于恶性骨肿瘤术后的患者,常被误诊为肿瘤复发。现总结我院收治的1例左股骨恶性肿瘤放疗后骨坏死误诊为肿瘤复发的患者的临床资料,初步报道如下。
[1]Strander H,Turesson I,Cavallin-St?hl E.A systematic overview of radiation therapy effects in soft tissue sarcomas[J].Acta Oncol,2003,42(56):516-531.
[2]Bentzen SM.Preventing or reducing late side effects of radiation therapy:radiobiology meets molecular pathology[J].Nat Rev Cancer,2006,6(9):702-713.
[3]Lane NE.Epidemiology,etiology,and diagnosis of osteoporosis[J].Am J Obstet Gynecol,2006,194(2 Suppl):S3-11.
[4]李建福,程天民.放射性骨损伤病理学改变的研究近况[J].中华放射医学与防护杂志,2000,20(3):77-80.
[5]Reginster JY,Neuprez A,Dardenne N,et al.Efficacy and safety of currently marketed anti-osteoporosis medications[J].Best Pract Res Clin Endocrinol Metab,2014,28(6):809-834.
[6]Baxter NN,Habermann EB,Tepper JE,et al.Risk of pelvic fractures in older women following pelvic irradiation[J].JAMA.2005,294(20):2587-2593.
[7]Bolek TW,Marcus RB Jr,Mendenhall NP,et al.Local control and functional results after twice-daily radiotherapy for Ewing's sarcoma of the extremities[J].Int J Radiat Oncol Biol Phys,1996,35(4):687-692.
[8]Aoki M,Sato M,Hirose K,et al.Radiation-induced rib fracture after stereotactic body radiotherapy with a total dose of 54~56 Gy given in 9~7 fractions for patients with peripheral lung tumor:impact of maximum dose and fraction size[J].Radiat Oncol,2015,10(1):99.
[9]Schmeler KM,Jhingran A,Iyer RB,et al.Pelvic fractures after radiotherapy for cervical cancer:implications for survivors[J].Cancer,2010,116(3):625-630.
[10]Emami B,Lyman J,Brown A,et al.Tolerance of normal tissue to therapeutic irradiation[J].Int J Radiat Oncol Biol Phys,1991,21(1):109-122.
[11]Hopewell JW,J Nyman,I Turesson I.Time factor for acute tissue reactions following fractionated irradiation:a balance between repopulation and enhanced radiosensitivity[J].Int J Radiat Biol,2003,79(7):513-524.
[12]王臻,王佳玉,徐海荣,等.肢体软组织肉瘤临床诊疗专家共识的解读[J].临床肿瘤学杂志,2014,22(7):637-648.
[13]Nicholls F,Janic K,Filomeno P,et al.Effects of radiation and surgery on healing of femoral fractures in a rat model[J].J Orthop Res,2013,31(8):1323-1331.
[14]张雪哲.骨坏死的影像学表现[J].中华放射学杂志,2006,40(5):451-454.
[15]张荣国.骨坏死45例的磁共振诊断及分析[J].转化医学电子杂志,2015,2(5):68-69.