Post-radiation sarcoma of the neck treated with re-irradiation followed by wide excision
Identifieur interne : 001C25 ( Pmc/Curation ); précédent : 001C24; suivant : 001C26Post-radiation sarcoma of the neck treated with re-irradiation followed by wide excision
Auteurs : Alex Tan [Australie] ; Samuel Yk Ngan [Australie] ; Peter Fm Choong [Australie]Source :
- World Journal of Surgical Oncology [ 1477-7819 ] ; 2006.
Abstract
Post-radiation sarcoma (PRS) is an uncommon disease manifesting as sarcoma in a previously irradiated field, usually with a latent period of 5 years or more. Literature is limited to small series. Optimal management of this disease is unclear. Positive margins are common following attempted curative surgery and outcomes are poor. Radiotherapy is hardly used and its effect on PRS is not known. We described a case of PRS treated with preoperative radiotherapy followed by margin-negative wide excision.
The 59-year-old patient presented with a mass in the left supraclavicular fossa and numbness in the arm, six years following radical irradiation of the head and neck for nasopharyngeal carcinoma. Open biopsy showed pleomorphic spindle cell sarcoma. She was treated with pre-operative hyperfractionated radiotherapy followed by margin-negative wide excision and nerve grafting. Cumulative radiation dose to the supraclavicular fossa was 98 Gy. Histological examination of the post-irradiation tumor specimens showed evidence of significant tumor response to re-irradiation. The patient remained free of disease five years after surgery with excellent functional outcome.
Role of radiotherapy in PRS is uncertain. We described a case that was successfully managed with preoperative radiotherapy and margin-negative wide excision in terms of tumor control and functional outcomes. The impact of radiotherapy was demonstrated in the post-irradiation resected specimen. Further investigation using re-irradiation and surgery in PRS is warranted.
Url:
DOI: 10.1186/1477-7819-4-69
PubMed: 17018155
PubMed Central: 1592488
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Post-radiation sarcoma (PRS) is an uncommon disease manifesting as sarcoma in a previously irradiated field, usually with a latent period of 5 years or more. Literature is limited to small series. Optimal management of this disease is unclear. Positive margins are common following attempted curative surgery and outcomes are poor. Radiotherapy is hardly used and its effect on PRS is not known. We described a case of PRS treated with preoperative radiotherapy followed by margin-negative wide excision.</p>
</sec>
<sec><title>Case presentation</title>
<p>The 59-year-old patient presented with a mass in the left supraclavicular fossa and numbness in the arm, six years following radical irradiation of the head and neck for nasopharyngeal carcinoma. Open biopsy showed pleomorphic spindle cell sarcoma. She was treated with pre-operative hyperfractionated radiotherapy followed by margin-negative wide excision and nerve grafting. Cumulative radiation dose to the supraclavicular fossa was 98 Gy. Histological examination of the post-irradiation tumor specimens showed evidence of significant tumor response to re-irradiation. The patient remained free of disease five years after surgery with excellent functional outcome.</p>
</sec>
<sec><title>Conclusion</title>
<p>Role of radiotherapy in PRS is uncertain. We described a case that was successfully managed with preoperative radiotherapy and margin-negative wide excision in terms of tumor control and functional outcomes. The impact of radiotherapy was demonstrated in the post-irradiation resected specimen. Further investigation using re-irradiation and surgery in PRS is warranted.</p>
</sec>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Surg Oncol</journal-id>
<journal-title>World Journal of Surgical Oncology</journal-title>
<issn pub-type="epub">1477-7819</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
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<article-meta><article-id pub-id-type="pmid">17018155</article-id>
<article-id pub-id-type="pmc">1592488</article-id>
<article-id pub-id-type="publisher-id">1477-7819-4-69</article-id>
<article-id pub-id-type="doi">10.1186/1477-7819-4-69</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
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<title-group><article-title>Post-radiation sarcoma of the neck treated with re-irradiation followed by wide excision</article-title>
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<contrib-group><contrib id="A1" contrib-type="author"><name><surname>Tan</surname>
<given-names>Alex</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<email>Alex.Tan@petermac.org</email>
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<contrib id="A2" corresp="yes" contrib-type="author"><name><surname>Ngan</surname>
<given-names>Samuel YK</given-names>
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<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I2">2</xref>
<email>Sam.Ngan@petermac.org</email>
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<contrib id="A3" contrib-type="author"><name><surname>Choong</surname>
<given-names>Peter FM</given-names>
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<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I2">2</xref>
<xref ref-type="aff" rid="I3">3</xref>
<email>sarcomasurgeon@ozemail.com.au</email>
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<aff id="I1"><label>1</label>
Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Australia</aff>
<aff id="I2"><label>2</label>
The University of Melbourne, Parkville, Australia</aff>
<aff id="I3"><label>3</label>
Department of Orthopedic Surgery, St Vincent's Hospital, Melbourne, Australia</aff>
<pub-date pub-type="collection"><year>2006</year>
</pub-date>
<pub-date pub-type="epub"><day>4</day>
<month>10</month>
<year>2006</year>
</pub-date>
<volume>4</volume>
<fpage>69</fpage>
<lpage>69</lpage>
<ext-link ext-link-type="uri" xlink:href="http://www.wjso.com/content/4/1/69"></ext-link>
<history><date date-type="received"><day>30</day>
<month>6</month>
<year>2006</year>
</date>
<date date-type="accepted"><day>4</day>
<month>10</month>
<year>2006</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2006 Tan et al; licensee BioMed Central Ltd.</copyright-statement>
<copyright-year>2006</copyright-year>
<copyright-holder>Tan et al; licensee BioMed Central Ltd.</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0"></ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
<pmc-comment>
Tan
Alex
Alex.Tan@petermac.org
Post-radiation sarcoma of the neck treated with re-irradiation followed by wide excision
2006 World Journal of Surgical Oncology 4(1): 69-. (2006) 1477-7819(2006)4:1<69> urn:ISSN:1477-7819 </pmc-comment>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>Post-radiation sarcoma (PRS) is an uncommon disease manifesting as sarcoma in a previously irradiated field, usually with a latent period of 5 years or more. Literature is limited to small series. Optimal management of this disease is unclear. Positive margins are common following attempted curative surgery and outcomes are poor. Radiotherapy is hardly used and its effect on PRS is not known. We described a case of PRS treated with preoperative radiotherapy followed by margin-negative wide excision.</p>
</sec>
<sec><title>Case presentation</title>
<p>The 59-year-old patient presented with a mass in the left supraclavicular fossa and numbness in the arm, six years following radical irradiation of the head and neck for nasopharyngeal carcinoma. Open biopsy showed pleomorphic spindle cell sarcoma. She was treated with pre-operative hyperfractionated radiotherapy followed by margin-negative wide excision and nerve grafting. Cumulative radiation dose to the supraclavicular fossa was 98 Gy. Histological examination of the post-irradiation tumor specimens showed evidence of significant tumor response to re-irradiation. The patient remained free of disease five years after surgery with excellent functional outcome.</p>
</sec>
<sec><title>Conclusion</title>
<p>Role of radiotherapy in PRS is uncertain. We described a case that was successfully managed with preoperative radiotherapy and margin-negative wide excision in terms of tumor control and functional outcomes. The impact of radiotherapy was demonstrated in the post-irradiation resected specimen. Further investigation using re-irradiation and surgery in PRS is warranted.</p>
</sec>
</abstract>
</article-meta>
</front>
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