Chest Infections: Student/Resident Case Report Poster - Chest Infections II |

Osteoradionecrosis and Osteomyelitis as a Long-term Complication of Cobalt Radiotherapy FREE TO VIEW

Kairavee Dave, MD; Vivek Choksi, MD; Todd Slesinger, MD; Erin Marra, MD
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Aventura Hospital and Medical Center, Aventura, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):183A. doi:10.1016/j.chest.2016.08.192
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SESSION TITLE: Student/Resident Case Report Poster - Chest Infections II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Radiotherapy is useful in the treatment of breast cancer of all stages. Cobalt radiotherapy has been used since the 1950s for breast-cancer management. However, since the advent of linear accelerators, its use has diminished. Post mastectomy radiotherapy has proven survival benefits especially in patients with >4 positive lymph nodes. Among node-positive patients there was a 37% relative reduction of distant metastases with radiation and a 22% relative reduction of death(1). The occurrence of short term and long term complications from exposure to the cobalt radiotherapy including recurrence of cancer, arm paralysis, recurrent laryngeal nerve paralysis and neuropathy depend largely upon the duration of exposure, volume of organs involved and the exposure site(2). We present an extremely rare case of osteomyelitis post cobalt radiotherapy. To our knowledge, this is the first case to be reported of osteoradionecrosis and osteomyelitis developing as a chronic complication post radical mastectomy and cobalt radiotherapy.

CASE PRESENTATION: An 89-year-old-female presented with complaints of erythema, yellow discharge and parts of ribs protruding from her upper right chest wall. Patient had bilateral radical mastectomy for breast cancer and underwent cobalt radiotherapy on the right side of chest wall 41 years ago. She had a total of 25 sessions of 1 hour long cobalt radiotherapy on the right chest post mastectomy. Patient was found to have an elevated sedimentation rate of 102 and normal white blood cell count. CT scan of the chest revealed changes suggestive of osteomyelitis and osteoradionecrosis of the right upper ribs. Treatment with IV vancomycin and piperacillin-tazobactam was initiated and plastic surgery consulted. During the admission, patient underwent debridement and resection of necrotic and infected bone and soft tissue. She was discharged with a total of 6 weeks of intravenous antibiotics and follow-up with plastic surgery for skin flap closure at a later date.

DISCUSSION: This is a unique and extremely rare long term complication of cobalt radiotherapy. The destructive effects of cobalt radiotherapy and decline in subcutaneous tissue with loss of skin elasticity, which is natural with the aging process likely resulted in the exposed ribs and osteomyelitis.

CONCLUSIONS: This unique case helps increase awareness of need for close follow up for surveillance of complications.

Reference #1: Auquier A, Rutqvist LE, Rotstein S, Høst H, Arriagada R. Post-mastectomy megavoltage radiotherapy: The Oslo and Stockholm trials. European Journal of Cancer. 1992 Mar 31;28(2):433-7.

Reference #2: Johansson S, Svensson H, Denekamp J. Timescale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients. International Journal of Radiation Oncology* Biology* Physics. 2000 Oct 1;48(3):745-50.

DISCLOSURE: The following authors have nothing to disclose: Kairavee Dave, Vivek Choksi, Todd Slesinger, Erin Marra

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