Chest wall osteoradionecrosis/osteomyelitis associated with radiotherapy in breast cancer: systematic review of literature and institutional series
DOI:
https://doi.org/10.29289/2594539420250009Keywords:
breast neoplasms, osteoradionecrosis, osteomyelitis, surgical flaps, chest wallAbstract
Osteoradionecrosis is uncommon and associated with breast cancer, with decreasing incidence. It can present as a local inflammatory process, skin ulceration, and bone changes, and may be associated with osteomyelitis. Clinical treatment is usually combined with surgical treatment. This study, with Certificate of Submission for Ethical Assessment (CAAE) 81761124.9.0000.5105, was approved by the Research Ethics Committee. A systematic literature review was conducted using the PICO (problem, intervention, comparison, and outcome) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodologies, conducted in two databases (the United States National Library of Medicine (PubMed) and the Latin American and Caribbean Literature on Health Sciences (LILACS). The descriptors used were: breast neoplasms and (osteoradionecrosis or osteomyelitis). Furthermore, we evaluated all institutional cases treated in the last five years. Using the terms, 125 studies were identified, 22 of which were included in the study. In the differential diagnosis with osteomyelitis, the most recommended tests are thoracic magnetic resonance imaging and triphasic scintigraphy. In general, clinical treatment does not control the lesion, requiring debridement (with or without rib resection) combined with the use of flaps, with myocutaneous flaps being the most commonly used. Two patients were treated at the service, representing 0.07% of the cases treated, one of whom had previously undergone breast-conserving treatment. All underwent resection, with the latissimus dorsi muscle being used for local coverage; one patient also underwent chest wall resection. In the presence of ulceration/osteoradionecrosis, a thorough evaluation should be performed to rule out osteomyelitis. Clinical treatment is generally ineffective. Surgical debridement with resection of the affected area, antibiotic therapy, and the use of myocutaneous flaps are good options for early recovery and local control.
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Copyright (c) 2025 René Aloisio da Costa Vieira, Mateus Augusto de Souza Santos, Polyana da Silva Caçador, Maria Carolina Marçon Barroso, Bruno Licy Gomes de Mello, Luiz Carlos Navarro de Oliveira
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