Two case reports are presented of radiation‐induced sarcomas occurring 23 years and 7 years after radiotherapy for breast carcinoma. One patient developed an undifferentiated sarcoma of the scapula believed to be induced by a calculated dose to the soft tissue component of bone of 8,195 rads in 3 weeks. The second patient had a fibrosarcoma involving the soft tissues of the axilla. Both patients died several months after diagnosis of the second neoplasm. A review of the literature disclosed 12 other cases in which a malignant tumor developed under similar circumstances. An analysis of these 12 cases and the 2 reported here showed that the most frequent site for the development of a malignant tumor was the scapula, and osteogenic sarcoma was the predominant histologic type encountered in these cases. Treatment with radical surgery or radiation was usually unsuccessful because most patients developed metastases early. A study of the reported cases brought out the fact that incompletely reported dosages made it impossible to calculate accurately doses of radiation absorbed in the target tissues. The authors present a scheme for presenting precise and informative physical data when future cases of radiation‐induced tumors are encountered. In order to diagnose these cases more accurately, criteria for evaluating the patient are presented.
In recent years external radiotherapy has been selected as primary treatment of patients with carcinoma of the prostate localized to the pelvis. Among 146 patients treated with external radiotherapy at Columbia-Presbyterian Medical Center, the 5 and 10 year survival rates were 64.1% and 40.5%, respectively.The 5-year survival rate was 88.2% for patients with Stage A, 86.8% for Stage B and 58% for Stage C; it was 64.4% for patients with more differentiated carcinomas, but only 28.7% for patients with undifferentiated tumors. Patients with obstructive changes on IVP had a 5 year survival rate of 24.1%, whereas, for patients with no obstruction on IVP, this rate was 71.3%. When radiotherapy started within 6 months after the diagnosis, the 5 year survival rate was 70.3%, whereas, a delay in starting radiotherapy, for more than 6 months after the diagnosis, was associated with a survival rate of 31.9%. Radiation dose of 6500 rad or more was associated with a 5-year survival rate of 86.7%, whereas, for a dose of less than 6500 rad this survival rate was 57.1%. All the above differences were statistically significant ( p < 0.05). Other factors that were examined and were found to influence the prognosis to a degree that was not statistically significant included: age of the patient at the time of radiotherapy, presenting symptoms, levels of acid phosphatase in the serum and in the bone marrow and size of the irradiated volume. In agreement with other published series the complications were usually mild and their incidence low. Tumor involving and protruding into the urethra may have contributed to the formation of urethral strictures. Local control of this cancer with external radiotherapy appears very successful. Treatment failures were manifested most often with distant metastases with or without local recurrence, suggesting that subclinical distant metastases might have been present prior to initiation of radiotherapy. External radiotherapy rather than brachyterhapy, appears to be the treatment of choice for cancer of the prostate with indications for radiotherapy.
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