中咽頭癌術後化学放射線治療後に化膿性脊椎炎を生じた1例

Pyogenic spondylitis after postoperative chemoradiotherapy for oropharyngeal carcinoma

放射線照射を受けた骨は，血行障害や骨脆弱性に伴う骨折や骨壊死，感染をきたしやすいことが知られている。頭頸部放射線治療後の骨有害事象として下顎骨壊死はよく知られているが，脊椎に関する骨有害事象の報告は少ない。今回，放射線照射後に頸胸椎の脆弱性骨折と化膿性脊椎炎をきたし，脊髄麻痺をきたした1例を経験したので，若干の文献的考察を加え報告する。

A 80’s male with oropharyngeal carcinoma received post-operative radiotherapy of 60 Gy in 30 fractions for primary lesion and regional lymphatic area. Post-operative radiotherapy was consisted of three-dimensional conformal radiotherapy of 10 Gy in five fractions and intensity-modulated radiotherapy（IMRT）of 50 Gy in 25 fractions. Chemotherapy（CDDP 100 mg/m², 3 course）was administered concurrently. After 10 years, pyogenic spondylitis occurred consistent with the area irradiated with 60 Gy. In IMRT planning for the head and neck cancer, the dose of vertebral bone is not constrained in general；however, late adverse events of the vertebral bone should be paid more attention.