Arrieta Oscar, Lozano-Ruiz Francisco, Guijosa Alberto, Soberanis-Pina Pamela, Blake-Cerda Monika, Gómez-García Ana Pamela, Maldonado-Magos Federico, Conde-Flores Emilio, Cardona Andrés F, Pérez Álvarez Sandra Ileana, Cabrera-Miranda Luis Antonio
Thoracic Oncology Unit, Departamento de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
Radiotherapy Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
Front Oncol. 2025 Feb 3;15:1438120. doi: 10.3389/fonc.2025.1438120. eCollection 2025.
As survival rates for lung cancer (LC) patients continue to rise, the adverse impacts of therapies become more relevant. Radiotherapy is known to negatively affect bone health. However, radiotherapy-induced vertebral fractures in lung cancer patients remain an exceedingly rare and underrecognized condition that could be mistaken for bone metastasis.
We identified three LC patients (all long-term survivors), aged 67 to 81, who developed thoracic vertebral fractures post-chest radiotherapy, within irradiated fields; two had advanced non-small cell lung cancer (NSCLC) and one had extensive small cell lung cancer (SCLC). Baseline imaging confirmed that the fractures occurred after therapy. The median time from radiotherapy to fracture onset was 19 months (range: 1-30 months), with a median follow-up time from the initial fracture of 39 months (range: 37-61 months). All observed fractures were compressive in nature. These patients shared common characteristics, including advanced age, a history of heavy smoking, and high radiation doses. Additionally, hypermetabolic activity at the fracture sites necessitated MRI to differentiate these fractures from bone metastases. Management involved interventional strategies such as vertebroplasty, kyphoplasty, and rhizotomy, along with general and pharmacological measures to prevent subsequent fractures.
Despite their low incidence, radiotherapy-induced vertebral fractures in LC patients are clinically significant and may resemble bone metastases on PET-CT imaging. MRI, alongside risk factors similar to those of osteoporosis, can facilitate prompt identification and differentiation. As survival rates in LC patients improve, the relevance of this adverse effect increases, underscoring the need for implementing bone protective strategies to further enhance patient outcomes and quality of life.
随着肺癌（LC）患者生存率持续提高，治疗的不良影响变得愈发重要。已知放射治疗会对骨骼健康产生负面影响。然而，肺癌患者放疗诱发的椎体骨折仍然极为罕见且未得到充分认识，可能会被误诊为骨转移。
我们确定了3例LC患者（均为长期存活者），年龄在67至81岁之间，在胸部放疗后，于照射野内发生胸椎骨折；2例患有晚期非小细胞肺癌（NSCLC），1例患有广泛期小细胞肺癌（SCLC）。基线影像学检查证实骨折发生在治疗后。从放疗至骨折发生的中位时间为19个月（范围：1 - 30个月），从初次骨折起的中位随访时间为39个月（范围：37 - 61个月）。所有观察到的骨折均为压缩性骨折。这些患者具有共同特征，包括高龄、大量吸烟史和高辐射剂量。此外，骨折部位的高代谢活性使得需要进行MRI检查以将这些骨折与骨转移区分开来。治疗措施包括椎体成形术、后凸成形术和神经根切断术等介入策略，以及预防后续骨折的一般措施和药物治疗。
尽管LC患者放疗诱发的椎体骨折发生率较低，但在临床上具有重要意义，并且在PET - CT成像上可能类似于骨转移。MRI以及与骨质疏松症相似的危险因素有助于快速识别和鉴别。随着LC患者生存率的提高，这种不良反应的相关性增加，强调需要实施骨骼保护策略以进一步改善患者的预后和生活质量。
