Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System

Abstract

The effects of radiation and chemotherapy on the musculoskeletal (MSK) system are diverse, and interpretation may be challenging. The different lines of treatment have effects on diseased and normal marrow, and they may lead to complications that must be differentiated from recurrence or progression. This review analyzes the changes induced by radiotherapy and chemotherapy in the MSK system in the adult and pediatric population, and the expected associated imaging findings. Treatments are often combined, so the effects may blend. Awareness of the spectrum of changes, complications, and their imaging appearances is paramount for the correct diagnosis. The assessment of body composition during and after treatment allows potential interventions to implement long-term outcomes and personalize treatments. Imaging techniques such as computed tomography or magnetic resonance imaging provide information on body composition that can be incorporated into clinical pathways. We also address future perspectives in posttreatment assessment.

Radiation-induced osteosarcoma of the chest wall after treatment for unresectable thymoma

“…Radiotherapy can be considered a “double-edged sword.” Beyond its cytotoxic effects on malignant cells, radiation is a well-known mutagen. When used therapeutically for many inoperable thoracic tumors, lower doses at the periphery of the irradiation zone render these regions at the highest risk for malignancy because these cells undergo DNA damage without cell death [5] . A uniform mechanism for radiation-induced carcinogenesis remains poorly understood, and each tissue type has its own sensitivity to radiation [6] .…”