Abstract
Aim: To present and highlight a remote complication following deep x-ray radiotherapy to Ilium.
Background: Radiotherapy is one the options to treat malignancy. Surrounding normal tissue can be affected by super-imposed infection, radiation-induced tumors, and other complications of radiation therapy. Timing of radiation changes varies in the different organs. Acute radiation pneumonitis is generally seen approximately 2 months after completion of radiotherapy, but radiation pericarditis not until 6–9 months after therapy. Radiation-induced sarcomas do not develop on average until 10–15 years after radiation therapy.
Case report: A 39-year old presented to an oral surgeon 29 years ago with a submandibular swelling that was gradually increasing in size. Excision biopsy revealed Follicular, Large cell, Non-Hogdkin’s Lymphoma. Lymphogram showed positive nodes in pelvic and para-aoric regions. She was treated with chemotherapy initially. She developed left SI joint pain 2 years later and was treated with radiotherapy. The lymphoma later became chemotherapy resistant and the patient was treated with whole body irradiation. She was in remission since 26 years. She started having discomfort in the left hip region far past 5 years and was reviewed. A recent MRI scan revealed avascular necrosis of the femoral head with little collapse. Changes in the ilium and muscle wasting around the left iliac wing were noted, which were consistent with post radiation osteonecrosis.
This lady noticed a recent change in the gait and examination revealed positive trendelenberg test and a lurching gait. Latest radiographs have shown a fracture of the left iliac crest. The patient did not request any surgical intervention and was reassured with explanation.
Conclusion: Post radiation osteonecrosis can cause complications as late as 26 years following deep x-ray radiotherapy.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
