Abstract WITH THE increasing frequency of the use of high voltage roentgen rays in the treatment of malignant neoplasms, the effects on normal tissue have become increasingly important to the radiotherapist and to the clinician. Not the least important of these effects are the changes occurring in bone and cartilage, although they do not appear to be widely familiar from a clinical point of view. Nevertheless, changes occurring in bone as a result of irradiation therapy have been reported since 1903, and in this paper we wish to review briefly the pathologic process involved and to present 2 cases, 1 of which is the third to be reported involving a male patient, as examples of the pathologic and the clinical importance of postirradiation lesions. Wammock and Arbuckle1 quoted Perthes, who described the effects of roentgen rays on epiphysial growth in 1903, and Cluzet, who in 1910 described delay in callus References 1. Wammock, H., and Arbuckle, R. K.: Fractures of the Rib Cage Following Interstitial Radium Therapy for Cancer of the Breast , Am. J. Roentgenol. 50:609-615 ( (Nov.) ) 1943. 2. Ewing, J.: Tissue Reactions to Radiation , Am. J. Roentgenol. 15:93-115 ( (Feb.) ) 1926. 3. Baensch, W., cited by Gratzek, Holmstrom and Rigler.18 4. Philipp, E., cited by Dalby, Jacox and Miller.6 Philipp, E., cited by Strauss and McGoldrick.9 5. Kropp, L., cited by Dalby, Jacox and Miller.6 Kropp, cited by Strauss and McGoldrick.9 6. Dalby, R. G.; Jacox, H. W., and N. F. Miller, abstracted, Fracture of the Femoral Neck Following Irradiation , Am. J. Obst. & Gynec. 32:50-59 ( (July) ) 1936. 7. Miller, N. F., and Folsome, C. E.: Carcinoma of the Cervix , Am. J. Obst. & Gynec. 36:545-561 ( (Oct.) ) 1938. 8. Okrainetz, C. L., and Biller, S. B.: Fracture of the Neck of the Femur Complicating Roentgen Therapy of Ovarian Cancer , Am. J. Roentgenol. 42:883-887 ( (Dec.) ) 1939. 9. Strauss, H., and McGoldrick, J. L.: Fracture of the Femoral Neck Following Roentgen Therapy for Gynecological Malignancy , Am. J. Obst. & Gynec. 41:915-933 ( (June) ) 1941. 10. Hight, D.: Spontaneous Fracture of the Femoral Neck Following Roentgen Ray Therapy Over the Pelvis , J. Bone & Joint Surg. 23:676 ( (July) ) 1941. 11. Baker, L. D.: Spontaneous Fracture of the Femoral Neck Following Irradiation , J. Bone & Joint Surg. 23:354-358 ( (April) ) 1941 12. Friedmann, A. B.: Spontaneous Rib Fractures Following Irradiation for Cancer of the Breast , Am. J. Roentgenol. 50:797-800 ( (Dec.) ) 1943. 13. Slaughter, D. P.: Radiation Osteitis and Fractures Following Irradiation , Am. J. Roentgenol. 48:201-212 ( (Aug.) ) 1942. 14. Gates, O.: Effects of Irradiation on Bone, Cartilage and Teeth , Arch. Path. 35:323-339 ( (Feb.) ) 1943. 15. Barden, S. P.: Healing of Radiation Fracture of the Necks of the Femora, with a Report of a Case , Radiology 41:389-394 ( (Oct.) ) 1943. 16. Heyman, C. H.: Spontaneous Bilateral Fracture of the Neck of the Femur Following Irradiation , J. Bone & Joint Surg. 27:674-678 ( (Oct.) ) 1945. 17. Smithers, D. W., and Rhys-Lewis, R. D. S.: Bone Destruction in Cases of Carcinoma of the Uterus , Brit. J. Radiol. 18:359 ( (Nov.) ) 1945. 18. Gratzek, F. R.; Holmstrom, E. G., and Rigler, L. G.: Post Irradiation Bone Changes , Am. J. Roentgenol. 53:62-76 ( (Jan.) ) 1945. 19. Spear, F. G.: The Biological Effects of Penetrating Radiation , Brit. M. Bull. 4:2-11, 1946. 20. Stampfli, W. P., and Kerr, H. D.: Fractures of the Femoral Neck Following Pelvic Irradiation , Am. J. Roentgenol. 57:71-83 ( (Jan.) ) 1947. 21. Woodard, H. Q., and Coley, B. L.: The Correlation of Tissue Dose and Clinical Response in Irradiation of Bone Tumors and of Normal Bone , Am. J. Roentgenol. 57:464-471 ( (April) ) 1947. 22. Phemister, D. B.: Changes in Bones and Joints Resulting from Interruption of Circulation , Arch. Surg. 41:436-472 ( (Aug.) ) 1940 23. Changes in Bones and Joints Resulting from Interruption of Circulation , Arch. Surg. 41:1455-1482 ( (Dec.) ) 1940. 24. Shackman, R., and Harrison, C. V.: Occult Bone Metastases , Brit. J. Surg. 35:385-389 ( (April) ) 1948.Crossref 25. Dunlap, C. E.: Pathology , edited by W. A. D. Anderson, St. Louis, C. V. Mosby Company, 1948, pp. 175-195. 26. Warren, S.: Effects of Radiation on Normal Tissues: I. Introduction , Arch. Path. 34:443 ( (Aug.) ) 1942 27. IV. The Cardio-Vascular System , Warren Arch. Path. 34:1070 ( (Dec.) ) 1942. 28. Santos, J. V.: Changes in the Head of the Femur after Complete Intracapsular Fracture of the Neck , Arch. Surg. 21:470 ( (Sept.) ) 1930.Crossref 29. Wolcott, W. E.: The Evolution of the Circulation in the Developing Femoral Head and Neck , Surg., Gynec. & Obst. 77:61-68 ( (July) ) 1943. 30. Cheynel, J.: Recherches sur la physio-pathologie de la hanche , Rev. d' orthop. 33:71947 31. Internat. Abstr. Surg. 85:495-496 ( (Nov.) ) 1947. 32. Tucker, F. R.: Arterial Supply to the Femoral Head and its Clinical Importance , J. Bone & Joint Surg. 31:82-93 ( (Feb.) ) 1949.
Archives of Surgery – American Medical Association
Published: Aug 1, 1950