An Instance of Radiation-Related Vertebral Displacement Fracture Simulating Solitary Bones Lung Cancer Metastatic Development

Title

An Instance of Radiation-Related Vertebral Displacement Fracture Simulating Solitary Bones Lung Cancer Metastatic Development

Author

1. Abla Bendahia, Student, Algiers Faculty of Medicine, Algeria

Abstract

The critical role of pharmaceuticals and radiotherapy in lung cancer management cannot be overstated. Despite the well-documented adverse effects of electromagnetic radiation, identifying them can often be a complex task. In a particular case, a male patient aged 58 was diagnosed with stage III squamous cell lung cancer, categorized as cT1aN2M0. His treatment regimen included a combination of biweekly chemotherapy using carboplatin and cisplatin over a six-week period, accompanied by a course of 80 Gy distributed across 30 sessions of thoracic radiotherapy. This was followed by bi-monthly administration of durvalumab over the course of a year.

At the conclusion of this durvalumab cycle, the patient complained of back discomfort. The cause was determined by magnetic resonance imaging to be a break caused by compression at the sixth thoracic spine.  Further imaging with a CT scan and chlorine-17 fluorodeoxyglucose PET scan indicated minimal uptake at the seventh thoracic vertebra, suggesting a potential for bone metastasis. However, this was not supported by a laparoscopic biopsy, which found no malignant cells. It was ultimately determined that a radiation-induced fracture was responsible for the symptoms, particularly since the fracture was located within the irradiated area near the seventh cervical vertebra.

 After the patient underwent surgery, a dual-energy X-ray absorptiometry scan revealed osteopenia in the spine. Initially, pre-surgery imaging had hinted at bone metastases, but ultimately, the postoperative biopsy was instrumental in diagnosing a fracture related to the radiation treatment, ruling out metastasis after the patient had undergone extensive chemotherapy and radiotherapy.

Keywords

Conclusion

This case report, following extensive CRT for non-small cell lung cancer, provides valuable insights into diagnosing and managing radiation-associated vertebral fractures. Faced with diagnostic ambiguity, healthcare providers should be vigilant about potential predisposing factors and risks. Continuous monitoring for bone toxicities associated with radiation therapy and immunotherapy is essential, and surgical biopsy should be considered when necessary.

Author Contrubution

The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.

Funding

The authors did not receive any specific grants from funding agencies in the public, commercial, or non-profit sectors for the research, authorship, and/or publication of this article.

Conflict of Interest

All authors declare that they have no conflicts of interest.

Data Sharing Statement

Not applicable

Software And Tools Use

Not applicable

Acknowledgements

I thank the following individuals for their expertise and assistance in all aspects of our study and for their help in writing the manuscript. I am also grateful for the insightful comments given by anonymous peer reviewers. Everyone's generosity and expertise have improved this study in myriad ways and saved me from many errors.