放射治疗在肺癌的治疗中起着重要的作用。虽然辐射的不利影响是众所周知的,他们有时很难被诊断出来。我们报告了一例与辐射相关的椎体压缩性骨折,该骨折模仿了肺癌的骨转移。该患者是一名57岁的男性,被诊断患有肺鳞状细胞癌(cT1aN2M0,c期IIIA)。他接受了同步放化疗(CRT),联合每周6周的卡铂加紫杉醇和60Gy/30分的胸部放疗,随后双周durvalumab持续12个月.在12个月durvalumab方案的最后一天,他抱怨背痛。磁共振成像显示第七胸椎压缩性骨折,脊髓受压,和氟-18氟脱氧葡萄糖正电子发射断层扫描和计算机断层扫描显示仅在第七胸椎的局灶性摄取较弱。尽管骨折被怀疑是骨转移,手术活检未发现恶性肿瘤.由于第七胸椎被包括在照射区域,患者被诊断为放射相关骨折.手术后腰椎(L2-4)的双能X线骨密度仪显示骨量减少。总之,我们成功诊断了根治性CRT引起的放射相关性椎体骨折。在术前影像学检查中骨折模仿骨转移。因此,手术活检有助于诊断.
Radiation therapy plays an important role in the treatment of lung cancer. Although adverse effects of radiation are well known, they are sometimes difficult to be diagnosed. We report a
case of a radiation-associated vertebral compression fracture which mimicked bone metastasis of lung cancer. The patient was a 57-year-old man diagnosed with lung squamous cell carcinoma (cT1aN2M0, c-stage IIIA). He received concurrent chemoradiotherapy (CRT) in combination with 6 weeks of weekly carboplatin plus paclitaxel and thoracic radiation of 60 Gy/30 fractions, followed by bi-weekly durvalumab for 12 months. On the last day of the 12-month durvalumab regimen, he complained of backache. Magnetic resonance imaging showed compression fracture of the seventh thoracic vertebra with the spinal cord compressed, and fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography demonstrated weak focal uptake only at the seventh thoracic vertebra. Although the fracture had been suspected to be bone metastasis, surgical biopsy revealed no evidence of malignancy. Since the seventh thoracic vertebra was included in the irradiation area, the patient was diagnosed with a radiation-associated fracture. Dual-energy X-ray absorptiometry of the lumbar vertebrae (L2 - 4) after the surgery revealed osteopenia. In conclusion, we successfully diagnosed the radiation-associated vertebral fracture caused by radical CRT. The fracture mimicked bone metastasis in preoperative imaging tests. Thus, surgical biopsy was useful for diagnosis.