Non-traumatic
osteonecrosis of bone is recognized as a potential complication in solid-tumour
cancer patients receiving treatment with cytotoxic
chemotherapy. This review summarizes recent reports of
osteonecrosis associated with
chemotherapy in
cancer patients, and describes the possible underlying pathophysiology and options available for its diagnosis, prevention and treatment. Fifty-four reported cases of non-traumatic
osteonecrosis in adult patients with solid tumours receiving
chemotherapy were identified by searching for reports in the medical literature.
Osteonecrosis was observed most commonly in men receiving
chemotherapy for
testicular cancer.
Osteonecrosis was also seen in patients receiving
chemotherapy for breast, ovarian,
small-cell lung cancer and
osteosarcoma. Most patients had received
corticosteroids, had femoral head involvement and had delayed onset of
osteonecrosis. It appears that patients at higher risk for
osteonecrosis with
chemotherapy are identifiable. As the long-term survival of patients with solid tumours receiving
chemotherapy increases, the prevalence of treatment-related
osteonecrosis may also increase. Patients should be informed that
osteonecrosis is a potential complication of
cancer treatment. Measures to reduce risk should be taken, and patients should be monitored for early symptoms. Routine screening for
chemotherapy-associated
osteonecrosis is not recommended; however, a high index of clinical suspicion in patients at risk may allow for early intervention and preservation of the joints.