EC Cancer

Chemotherapy-associated osteonecrosis is a rare but significant complication of cancer treatment, characterized by bone necrosis resulting from disrupted vascular supply. This condition is most often associated with cytotoxic agents such as doxorubicin, cisplatin, and ifosfamide, which are known to inhibit angiogenesis, induce osteocyte apoptosis, and impair bone metabolism. MRI plays a crucial role in the early diagnosis with characteristic findings including serpiginous borders and distinct signal abnormalities on T1- and T2-weighted sequences. Although typically asymptomatic in its early stages, undetected osteonecrosis may progress to joint collapse, significantly impacting a patient’s quality of life. We report the case of a 28 years-old asymptomatic male, treated with chemotherapy for an osteosarcoma without any other relevant medical history, presenting imaging signs of osteonecrosis.

 Keywords: Osteonecrosis; Osteosarcoma; Chemotherapy; MRI

1. Shim K., et al. “Chemotherapy-associated osteonecrosis in cancer patients with solid tumours a systematic review”. Drug Safety5 (2008): 359-371.
2. Fan C., et al. “Pathobiology and prevention of cancer chemotherapy-induced bone growth arrest, bone loss, and osteonecrosis”. Current Molecular Medicine2 (2011): 140-151.
3. Marcianò A., et al. “Cancer patients at risk for medication-related osteonecrosis of the jaw. A case and control study analyzing predictors of mronj onset”. Journal of Clinical Medicine 20 (2021): 4762.
4. Stacy GS., et al. “Infarct-associated bone sarcomas: Multimodality imaging findings”. American Journal of Roentgenology4 (2015): W432-W441.
5. Domson GF., et al. “Infarct-associated bone sarcomas”. Clinical Orthopaedics and Related Research 7 (2009): 1820-1825.
6. Laranga R., et al. “Bone infarct-associated osteosarcoma: epidemiologic and survival trends”. Oncology Research and Treatment 6 (2022): 326-335.
7. Mancuso S., et al. “Bone damage after chemotherapy for lymphoma: a real-world experience”. BMC Musculoskeletal Disorders 1 (2021): 1024.