From radiation osteitis to osteoradionecrosis

• Verfasst von: Meixel, Adrian J. [VerfasserIn]
• Verfasst von: Hauswald, Henrik [VerfasserIn]
• Verfasst von: Delorme, Stefan [VerfasserIn]
• Verfasst von: Jobke, Björn [VerfasserIn]
• Titel: From radiation osteitis to osteoradionecrosis
• Titelzusatz: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy
• Verf.angabe: Adrian J. Meixel, Henrik Hauswald, Stefan Delorme, Björn Jobke
• E-Jahr: 2018
• Jahr: 23 February 2018
• Umfang: 10 S.
• Fussnoten: Gesehen am 26.03.2020
• Titel Quelle: Enthalten in: European radiology
• Ort Quelle: Berlin : Springer, 1991
• Jahr Quelle: 2018
• Band/Heft Quelle: 28(2018), 8, Seite 3550-3559
• ISSN Quelle: 1432-1084
• ISSN Quelle: 1613-3757
• DOI: doi:10.1007/s00330-018-5325-2
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Adult
• Sach-SW: Aged
• Sach-SW: Aged, 80 and over
• Sach-SW: Bone marrow
• Sach-SW: Causality
• Sach-SW: Comorbidity
• Sach-SW: Female
• Sach-SW: Follow-Up Studies
• Sach-SW: Fractures, Stress
• Sach-SW: Humans
• Sach-SW: Incidence
• Sach-SW: Insufficiency fracture
• Sach-SW: Magnetic Resonance Imaging
• Sach-SW: Male
• Sach-SW: Middle Aged
• Sach-SW: Osteitis
• Sach-SW: Osteoradionecrosis
• Sach-SW: Pelvic Neoplasms
• Sach-SW: Pelvis
• Sach-SW: Radiation
• Sach-SW: Radiation Injuries
• Sach-SW: Radiography
• Sach-SW: Retrospective Studies
• Sach-SW: Risk Factors
• Sach-SW: Sacrum
• Sach-SW: Time Factors
• Sach-SW: Young Adult
• K10plus-PPN: 1693405237

Abstract

OBJECTIVE: To investigate the incidence rate, time-to-onset and recovery, MRI morphology and occurrence of insufficiency fractures in radiation-induced changes in the sacrum following pelvic radiotherapy. - MATERIAL AND METHODS: 410 patients with pelvic malignancies treated with radiotherapy were reviewed. Follow-up was 1-124 months (mean 22 months). Serial MRI (average four studies/patient) were analysed using a new semi-quantitative score (Radiation-Induced Sacral Changes=RISC). A size category (I/II/III), a type category for MR signal morphologies (a/b/c) and sacral insufficiency fractures (+/-) were applied. - RESULTS: Seventy-two patients (17.6 %) were found to have new pathological signal changes. Radiation osteitis was documented in 83.3 % (60/72, RISC stage a + b), and definite osteonecrosis (stage c) in 12 patients (16.7 %, 12/72). Thirty-one patients (43.1 %) had sacral insufficiency fractures. Initial bone marrow signal changes were found 1-35 months (median 4 months) after radiotherapy. The maximum manifestation of radiation-induced signal changes occurred after 1-35 months (mean 11 months). Fifty-six cases (77.8 %) showed a significant signal recovery within 16.5 months. - CONCLUSION: Radiation-induced bone marrow changes appear with a high incidence at the sacrum with an early onset and frequent recovery. The majority presented a pattern of radiation osteitis, whereas osteoradionecrosis was proportionately rare. - KEY POINTS: • Radiation-induced sacral bone marrow changes appear frequently (17.6 %) following pelvic radiotherapy. • Insufficiency fractures are common late effects (43 %). • Radiation osteitis develops early (4 mo), with recovery between 16.5 and 39.5 months. • Definite radiological osteoradionecrosis is proportionately rare (3 %). • A 3-stage classification system simplifies and standardizes the morphological disease staging.