Authors: Alshakankery Safaa, Ellathy Hala, Alghamdi Susan, Aldhafiri Ahmed.
Introduction: Cervical cancer is reported as the fourth most common cancer among females worldwide after breast, colorectal, and lung cancer. In Saudi Arabia it is the eighth most common form of cancer among females aged 15 to 44 years. Squamous cell carcinoma is the most common subtype of cervical cancer, followed by adenocarcinoma. Radiotherapy has a principal role in the management of locally advanced cervical cancer, either as an adjuvant treatment after surgery in the presence of risk factors or as a primary curative treatment, used in combination with chemotherapy and a brachytherapy boost to the primary site.
Radiotherapy for patients with cervical cancer has been used as an effective cure and increasing rates of long-term survival. Pelvic Radiation can cause variable side effects on pelvic organs including the small bowel, rectum, anus, bone and bone marrow, bladder, urethra, ureter, vulva, vagina, uterus, ovaries, and sexual organs.
Aim: The aim of this report is to present a case of femoral head necrosis after a therapeutic pelvic irradiation of cervical cancer to draw physicians’ attention to that clinical problem which continues to be underestimated. It is necessary to consider bone structures among organ at risk (OAR) involved in irradiation fields and differentiate the bone changes secondary to radiation exposure from bone metastasis, also differentiate radiation-induced sarcoma as late complication to avoid improper management.
Case Report: A 35-year-old female was diagnosed with locally advanced squamous cell carcinoma of the cervix (international Federation of Gynecology and Obstetrics International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1) after she presented to the gynecologist complaining of post-coital vaginal bleeding and intermenstrual bleeding.
The patient received chemoradiotherapy followed by brachytherapy. After completion of treatment, she had a follow up radiological imaging which revealed a complete radiological and pathological response. During her routine followup, she complained of tingling electric pain with numbness referred to her back and lower limbs, PET scan revealed non avid right femoral head and right ala of the sacrum lesions likely post radiotherapy osteonecrosis. Follow up after 3-months with MRI pelvis confirmed the diagnosis of post radiotherapy osteonecrosis.
Conclusion: The radiotherapy tends to be used to treat advanced stage cervical cancer, and these patients usually do well clinically. However, radiation exposure can initiate regional complications to the exposed pelvic organs. Pelvic bone osteonecrosis is a serious complication of pelvic radiation which may affect patients’ quality of life and requires more attention.
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