We present a rare case report of a bilateral avascular necrosis of lateral sacral masses in a patient who developed a sustainable complete clinical and radiological response after chemoradiotherapy for locally advanced rectal cancer. It is shown that despite the standardized and precise planning and fractioning for neoadjuvant chemoradiation therapy for locally advanced rectal cancer, the biological effects of ionizing radiation on critical organs can be va- ried both in time of occurrence and in structure. Evaluating the effect of neoadjuvant chemoradiation therapy, one should take into account the possibility of the development of even very rare effects of ionizing radiation on criti- cal organs and include their early detection in the diagnostic algorithm.
Predstavleno ridkisnyy̆ klinichnyy̆ vypadok dvostoronn'ogo avaskuliarnogo nekrozu bichnykh kryzhovykh mas u patsiienta z povnym klinichnym ta radiologichnym regresom mistsevo poshyrenogo raku priamoï kyshky pislia khimiopro- menevoï terapiï.Pokazano, shcho nezvazhaiuchy na standartyzovanu i pretsyziy̆nu tekhniku planuvannia, fraktsionuvan- nia i dozymetrychnogo kontroliu za provedenniam neoad'iuvantnoï khimiopromenevoï terapiï z pryvodu mistsevo po- shyrenogo raku priamoï kyshky, biologichni efekty ionizuiuchogo vyprominiuvannia na krytychni organy mozhut' maty riznomanitnyy̆ kharakter iak za chasom vynyknennia, tak i za svoieiu strukturoiu. Otsiniuiuchy efekt neoad'iuvantnoï khimiopromenevoï terapiï, slid braty do uvagy mozhlyvist' rozvytku navit' duzhe ridkisnykh efektiv ionizuiuchogo vyprominiuvannia z boku krytychnykh organiv i vkliuchaty ïkh rannie vyiavlennia v diagnostychnyy̆ algorytm.
Keywords: avascular necrosis of lateral sacral masses; locally advanced rectal cancer; neoadjuvant chemoradiation therapy.
V. V. Zvirych, D. E. Makhmudov, M. I. Paliiy, A. V. Ashykhmin, O. O. Kolesnik.