Postradiation sarcomas: 20 cases and a literature review
Identifieur interne : 000977 ( Istex/Corpus ); précédent : 000976; suivant : 000978Postradiation sarcomas: 20 cases and a literature review
Auteurs : Elizabeth M. Murray ; Dudley Werner ; Elizabeth A. Greeff ; Deryck A. TaylorSource :
- International Journal of Radiation Oncology, Biology, Physics [ 0360-3016 ] ; 1999.
English descriptors
- KwdEn :
Abstract
Purpose: To analyze 20 cases of postradiation sarcoma (PRS) to determine dose levels at which this condition developed, the pathology of the initial and postradiation tumors, latency period, and outcome; and to review the literature and propose modified criteria for diagnosis. Methods and Materials: Patient records were reviewed. Previous radiation fields and isodose charts were reconstructed to determine the dose received in the tissue in which the PRS subsequently developed. Results: There were 16 female patients and 4 male patients. Mean age at the time of initial radiotherapy was 28 years. Mean latency was 14 years, with no difference in latency between the adult and pediatric group (t = 0.45, p = 0.37), but shorter latency in the retinoblastoma than in the nonretinoblastoma patients (t = 3.18, p = 0.003). The outcome was poor; 2 patients were alive and disease-free at 2 and 5 years. The 18 patients who died as a result of PRS had a median survival of 1 year. Conclusion: PRSs are rare. Unnecessary radiation must be avoided. Cases should be reported with full details so that risk factors can be ascertained. PRSs usually arise in moderate to higher dose areas. Diagnostic criteria should allow soft tissue tumors and short latency.
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DOI: 10.1016/S0360-3016(99)00279-5
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<front><div type="abstract" xml:lang="en">Purpose: To analyze 20 cases of postradiation sarcoma (PRS) to determine dose levels at which this condition developed, the pathology of the initial and postradiation tumors, latency period, and outcome; and to review the literature and propose modified criteria for diagnosis. Methods and Materials: Patient records were reviewed. Previous radiation fields and isodose charts were reconstructed to determine the dose received in the tissue in which the PRS subsequently developed. Results: There were 16 female patients and 4 male patients. Mean age at the time of initial radiotherapy was 28 years. Mean latency was 14 years, with no difference in latency between the adult and pediatric group (t = 0.45, p = 0.37), but shorter latency in the retinoblastoma than in the nonretinoblastoma patients (t = 3.18, p = 0.003). The outcome was poor; 2 patients were alive and disease-free at 2 and 5 years. The 18 patients who died as a result of PRS had a median survival of 1 year. Conclusion: PRSs are rare. Unnecessary radiation must be avoided. Cases should be reported with full details so that risk factors can be ascertained. PRSs usually arise in moderate to higher dose areas. Diagnostic criteria should allow soft tissue tumors and short latency.</div>
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<notesStmt><note type="content">Section title: Clinical Investigations</note>
<note type="content">Fig. 1: Case 6. (a) One anterior and posterior field, and two radium insertions; secondary tumor in anterior field. (b) Total gray distribution 1 cm inferior to central axis. Level through secondary tumor. (c) CT scan showing postradiation tumor abdominal wall. Shaded area = tumor, ♢ = maximum dose point, × = field center entrance.</note>
<note type="content">Fig. 2: Case 13. (a) Five planned fields. Secondary tumor in relation to left fields. (b) Total gray distribution central axis level through mid-secondary tumor. (c) CT scan showing postradiation tumor of the orbit. Shaded area = tumor, ♢ = maximum dose point, × = field center entrance.</note>
<note type="content">Fig. 3: Case 18. (a) Right and left lateral fields, two courses. Secondary tumor in relation to fields. (b) Total gray distribution 7.5 cm inferior to central axis. Level through main tumor mass. (c) Plain radiograph showing postradiation osteosarcoma. Shaded area = tumor, ♢ = maximum dose point, × = field center entrance.</note>
<note type="content">Fig. 4: Histogram showing dose levels at which PRS occurred with three-point moving average graph superimposed.</note>
<note type="content">Table 1: Postradiation sarcomas: 20 cases from the University of Cape Town, South Africalegend legend legend legend legend legend</note>
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<abstract xml:lang="en"><p>Purpose: To analyze 20 cases of postradiation sarcoma (PRS) to determine dose levels at which this condition developed, the pathology of the initial and postradiation tumors, latency period, and outcome; and to review the literature and propose modified criteria for diagnosis. Methods and Materials: Patient records were reviewed. Previous radiation fields and isodose charts were reconstructed to determine the dose received in the tissue in which the PRS subsequently developed. Results: There were 16 female patients and 4 male patients. Mean age at the time of initial radiotherapy was 28 years. Mean latency was 14 years, with no difference in latency between the adult and pediatric group (t = 0.45, p = 0.37), but shorter latency in the retinoblastoma than in the nonretinoblastoma patients (t = 3.18, p = 0.003). The outcome was poor; 2 patients were alive and disease-free at 2 and 5 years. The 18 patients who died as a result of PRS had a median survival of 1 year. Conclusion: PRSs are rare. Unnecessary radiation must be avoided. Cases should be reported with full details so that risk factors can be ascertained. PRSs usually arise in moderate to higher dose areas. Diagnostic criteria should allow soft tissue tumors and short latency.</p>
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<ce:roles>M.Med.</ce:roles>
<ce:cross-ref refid="AFF1">∗</ce:cross-ref>
<ce:cross-ref refid="CORR1">*</ce:cross-ref>
<ce:e-address>emurray@ray.uct.ac.za</ce:e-address>
</ce:author>
<ce:author><ce:given-name>Dudley</ce:given-name>
<ce:surname>Werner</ce:surname>
<ce:roles>F.R.C.R.</ce:roles>
<ce:cross-ref refid="AFF1">∗</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Elizabeth A</ce:given-name>
<ce:surname>Greeff</ce:surname>
<ce:roles>H.D.Rad(T)</ce:roles>
<ce:cross-ref refid="AFF1">∗</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Deryck A</ce:given-name>
<ce:surname>Taylor</ce:surname>
<ce:degrees>Ph.D.</ce:degrees>
<ce:cross-ref refid="AFF2"><ce:sup>†</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:affiliation id="AFF1"><ce:label>∗</ce:label>
<ce:textfn>Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF2"><ce:label>†</ce:label>
<ce:textfn>Department of Anatomical Pathology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</ce:textfn>
</ce:affiliation>
<ce:correspondence id="CORR1"><ce:label>*</ce:label>
<ce:text>Reprint requests to: E. M. Murray, Radiation Oncology, Groote Schuur Hospital, Observatory 7925, South Africa. Tel: +27-21-404-4267; Fax: +27-21-448-5707</ce:text>
</ce:correspondence>
</ce:author-group>
<ce:date-accepted day="30" month="6" year="1999"></ce:date-accepted>
<ce:abstract><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para>Purpose: To analyze 20 cases of postradiation sarcoma (PRS) to determine dose levels at which this condition developed, the pathology of the initial and postradiation tumors, latency period, and outcome; and to review the literature and propose modified criteria for diagnosis.</ce:simple-para>
<ce:simple-para>Methods and Materials: Patient records were reviewed. Previous radiation fields and isodose charts were reconstructed to determine the dose received in the tissue in which the PRS subsequently developed.</ce:simple-para>
<ce:simple-para>Results: There were 16 female patients and 4 male patients. Mean age at the time of initial radiotherapy was 28 years. Mean latency was 14 years, with no difference in latency between the adult and pediatric group (<ce:italic>t</ce:italic>
= 0.45, <ce:italic>p</ce:italic>
= 0.37), but shorter latency in the retinoblastoma than in the nonretinoblastoma patients (<ce:italic>t</ce:italic>
= 3.18, <ce:italic>p</ce:italic>
= 0.003). The outcome was poor; 2 patients were alive and disease-free at 2 and 5 years. The 18 patients who died as a result of PRS had a median survival of 1 year.</ce:simple-para>
<ce:simple-para>Conclusion: PRSs are rare. Unnecessary radiation must be avoided. Cases should be reported with full details so that risk factors can be ascertained. PRSs usually arise in moderate to higher dose areas. Diagnostic criteria should allow soft tissue tumors and short latency.</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
<ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title>
<ce:keyword><ce:text>Postradiation sarcomas</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Radiation complications</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Radiation-induced human sarcomas</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Radiation therapy</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Giant cell tumors</ce:text>
</ce:keyword>
</ce:keywords>
</head>
</converted-article>
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<mods version="3.6"><titleInfo lang="en"><title>Postradiation sarcomas: 20 cases and a literature review</title>
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<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Postradiation sarcomas: 20 cases and a literature review</title>
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<name type="personal"><namePart type="given">Elizabeth M</namePart>
<namePart type="family">Murray</namePart>
<affiliation>Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</affiliation>
<affiliation>Reprint requests to: E. M. Murray, Radiation Oncology, Groote Schuur Hospital, Observatory 7925, South Africa. Tel: +27-21-404-4267; Fax: +27-21-448-5707</affiliation>
<affiliation>E-mail: emurray@ray.uct.ac.za</affiliation>
<description>M.Med.</description>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Dudley</namePart>
<namePart type="family">Werner</namePart>
<affiliation>Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</affiliation>
<description>F.R.C.R.</description>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Elizabeth A</namePart>
<namePart type="family">Greeff</namePart>
<affiliation>Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</affiliation>
<description>H.D.Rad(T)</description>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Deryck A</namePart>
<namePart type="family">Taylor</namePart>
<namePart type="termsOfAddress">Ph.D.</namePart>
<affiliation>Department of Anatomical Pathology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa</affiliation>
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<copyrightDate encoding="w3cdtf">1999</copyrightDate>
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<abstract lang="en">Purpose: To analyze 20 cases of postradiation sarcoma (PRS) to determine dose levels at which this condition developed, the pathology of the initial and postradiation tumors, latency period, and outcome; and to review the literature and propose modified criteria for diagnosis. Methods and Materials: Patient records were reviewed. Previous radiation fields and isodose charts were reconstructed to determine the dose received in the tissue in which the PRS subsequently developed. Results: There were 16 female patients and 4 male patients. Mean age at the time of initial radiotherapy was 28 years. Mean latency was 14 years, with no difference in latency between the adult and pediatric group (t = 0.45, p = 0.37), but shorter latency in the retinoblastoma than in the nonretinoblastoma patients (t = 3.18, p = 0.003). The outcome was poor; 2 patients were alive and disease-free at 2 and 5 years. The 18 patients who died as a result of PRS had a median survival of 1 year. Conclusion: PRSs are rare. Unnecessary radiation must be avoided. Cases should be reported with full details so that risk factors can be ascertained. PRSs usually arise in moderate to higher dose areas. Diagnostic criteria should allow soft tissue tumors and short latency.</abstract>
<note type="content">Section title: Clinical Investigations</note>
<note type="content">Fig. 1: Case 6. (a) One anterior and posterior field, and two radium insertions; secondary tumor in anterior field. (b) Total gray distribution 1 cm inferior to central axis. Level through secondary tumor. (c) CT scan showing postradiation tumor abdominal wall. Shaded area = tumor, ♢ = maximum dose point, × = field center entrance.</note>
<note type="content">Fig. 2: Case 13. (a) Five planned fields. Secondary tumor in relation to left fields. (b) Total gray distribution central axis level through mid-secondary tumor. (c) CT scan showing postradiation tumor of the orbit. Shaded area = tumor, ♢ = maximum dose point, × = field center entrance.</note>
<note type="content">Fig. 3: Case 18. (a) Right and left lateral fields, two courses. Secondary tumor in relation to fields. (b) Total gray distribution 7.5 cm inferior to central axis. Level through main tumor mass. (c) Plain radiograph showing postradiation osteosarcoma. Shaded area = tumor, ♢ = maximum dose point, × = field center entrance.</note>
<note type="content">Fig. 4: Histogram showing dose levels at which PRS occurred with three-point moving average graph superimposed.</note>
<note type="content">Table 1: Postradiation sarcomas: 20 cases from the University of Cape Town, South Africalegend legend legend legend legend legend</note>
<subject><genre>article-category</genre>
<topic>Sarcoma</topic>
</subject>
<subject lang="en"><genre>Keywords</genre>
<topic>Postradiation sarcomas</topic>
<topic>Radiation complications</topic>
<topic>Radiation-induced human sarcomas</topic>
<topic>Radiation therapy</topic>
<topic>Giant cell tumors</topic>
</subject>
<relatedItem type="host"><titleInfo><title>International Journal of Radiation Oncology, Biology, Physics</title>
</titleInfo>
<titleInfo type="abbreviated"><title>ROB</title>
</titleInfo>
<genre type="journal">journal</genre>
<originInfo><dateIssued encoding="w3cdtf">19991101</dateIssued>
</originInfo>
<identifier type="ISSN">0360-3016</identifier>
<identifier type="PII">S0360-3016(00)X0069-7</identifier>
<part><date>19991101</date>
<detail type="volume"><number>45</number>
<caption>vol.</caption>
</detail>
<detail type="issue"><number>4</number>
<caption>no.</caption>
</detail>
<extent unit="issue pages"><start>835</start>
<end>1094</end>
</extent>
<extent unit="pages"><start>951</start>
<end>961</end>
</extent>
</part>
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<identifier type="istex">14E4502C3AB78AF8E697B968AE4AFB9AFC5C0B29</identifier>
<identifier type="DOI">10.1016/S0360-3016(99)00279-5</identifier>
<identifier type="PII">S0360-3016(99)00279-5</identifier>
<accessCondition type="use and reproduction" contentType="copyright">©1999 Elsevier Science Inc.</accessCondition>
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