Complications associated with treatment of malignancies: a focus on avascular necrosis of the bone.

Cancer patients have a better prognosis now than in the past. An estimated 66% of patients diagnosed with cancer between 1996 and 2004 were alive at 5 years.1 As patients are living longer after treatment, long-term complications associated with treatment are becoming a greater issue. Avascular necrosis, also referred to as osteonecrosis, ischemic necrosis, subchondral avascular necrosis, aseptic necrosis of bone, and osteochondritis dissecans, is one such complication.2 Avascular necrosis is a disorder involving breakdown of the bone and has been reported as a complication associated with a number of different disease states and drug therapies. Joint replacement surgery may be required in cases of severe bone destruction, and avascular necrosis has been reported to be the cause for 10% of joint replacement procedures in the United States.2 Chemotherapy agents and other medications used in the treatment of malignancy have been associated with the development of avascular necrosis, including corticosteroids, bisphosphonates, asparaginase, and others (Sidebar). It is important to be aware of these potential drug causes of avascular necrosis, as early recognition and management of the disease process, including early cessation of causative therapy, is necessary to improve patient outcomes, reduce morbidity, and improve quality of life.2