Osteoradionecrosis of the chest wall in a patient with invasive ductal carcinoma of the breast: a case report

Introduction and importance: Osteoradionecrosis following radiotherapy is quite rare in locations other than the jaw. In this case report, we described a patient with breast cancer who developed osteoradionecrosis of the chest wall following radiotherapy treatment for breast cancer. Case presentation: A 60-year-old woman with a history of right breast invasive ductal carcinoma treated with mastectomy and radiotherapy presented with extensive soft tissue and rib necrosis on the right chest wall. Due to the severity of the necrosis, she underwent surgical debridement and reconstruction, including resection of five anterior ribs and part of the lateral sternum. Part of the defect was covered using a latissimus dorsi and serratus anterior myocutaneous flap, while the remaining area was managed with negative-pressure wound therapy and later skin grafting, achieving full healing within 2 weeks. Clinical discussion: Osteoradionecrosis of the chest wall can present with ulcers, infection, hemorrhage, rib pain, or even pathological fractures, sometimes presenting up to a year after radiotherapy. Early recognition is often delayed, especially outside the jaw, but timely diagnosis and management can reduce necrosis and improve outcomes, including aesthetic results. Imaging, such as positron emission tomography or contrast-enhanced computed tomography, may aid in early differentiation from other conditions like metastasis. Conclusion: Osteoradionecrosis can develop in any area of the body exposed to radiotherapy and may occur in unusual sites such as the chest. Early diagnosis and management are crucial, as delayed intervention may lead to extensive necrosis and poor aesthetic outcomes.