Beşe Nuran Senel, Ozgüroğlu Mustafa, Kamberoğlu Kaya, Karahasanoglu Tayfun, Ober Ahmet
Department of Radiation Oncology, Medical Oncology Section, Cerrahpaşa Medical School, Istanbul University, Turkey.
Radiat Med. 2003 Sep-Oct;21(5):223-7.
The reported incidence of bone complications after radiation therapy is quite low. The most commonly seen bone complication is insufficiency fractures of the pubis and sacrum. Treatment of insufficiency fractures consists of conservative care, and mineral replacement may be useful. The resolution of symptoms takes at least one year with these treatments. Vascular damage has an important role in the etiology of late radiation injury in normal tissues. Progressive ischemic changes further weaken the bone structure, which can cause fractures, and healing is also delayed. Pentoxifylline is a methylxanthine derivative that is shown to increase tissue blood flow. Here, we present a 63-year-old male patient with pelvic insufficiency fractures due to postoperative pelvic irradiation for rectal adenocarcinoma. The patient received pelvic radiotherapy to a total dose of 50.4 Gy with concomitant 5-FU. Six months after the completion of radiotherapy, the patient presented with severe pelvic pain. Pelvic magnetic resonance imaging (MRI) demonstrated abnormal signal intensity with insufficiency fractures at the sacrum and bone marrow edema near the fractures, but not an abnormal intensity that revealed bone metastases. Neither distant nor locoregional recurrence was observed at his work-up. The final diagnosis was insufficiency fractures of the pelvic bones owing to irradiation, and pentoxifylline (400 mg, 3 times daily, peroral, 1,200 mg/day) was used for eight months as treatment. Dramatic clinical improvement was obtained in six months, and objective healing was revealed with MRI. We concluded that pentoxifylline is a cost-effective drug with minimal adverse effects in treating radiation damage of bone.
放疗后骨并发症的报告发生率相当低。最常见的骨并发症是耻骨和骶骨的不全骨折。不全骨折的治疗包括保守治疗，补充矿物质可能会有帮助。采用这些治疗方法，症状缓解至少需要一年时间。血管损伤在正常组织晚期放射损伤的病因中起重要作用。进行性缺血性改变会进一步削弱骨骼结构，从而导致骨折，且愈合也会延迟。己酮可可碱是一种甲基黄嘌呤衍生物，已证明其可增加组织血流量。在此，我们报告一名63岁男性患者，因直肠腺癌术后盆腔放疗出现盆腔不全骨折。该患者接受盆腔放疗，总剂量为50.4 Gy，同时使用5-氟尿嘧啶。放疗结束6个月后，患者出现严重盆腔疼痛。盆腔磁共振成像（MRI）显示信号强度异常，骶骨有不全骨折，骨折附近有骨髓水肿，但未发现提示骨转移的异常信号强度。在其检查中未观察到远处或局部复发。最终诊断为放疗引起的盆腔骨不全骨折，使用己酮可可碱（400毫克，每日3次，口服，1200毫克/天）治疗8个月。6个月时临床症状显著改善，MRI显示达到客观愈合。我们得出结论，己酮可可碱在治疗骨放射损伤方面是一种具有成本效益且不良反应最小的药物。
