Radiation-Induced Sarcomas of the Head and Neck: A Systematic Review

Abstract

Introduction As a result of the increased use of radiotherapy (RT) and improved long-term overall survival of patients with cancers of the head and neck (HN), the frequency of radiation-induced sarcomas of the head and neck (RISHN) may be increasing. The main objective of this systematic review was to determine the existing evidence on the frequency, treatment, and outcome of RISHN. Methods Using PRISMA guidelines we conducted a systematic review of the literature published from 2000 to 2020. Results Our review includes data of 560 patients from 64 articles. The total frequency of RISHNs among the reviewed series was 0.15%. The most frequent location of the primary tumor treated by RT was the nasopharynx. The mean RT dose used was 62 Gy, mean latency interval between irradiation and occurrence of RISHN was 11.1 years, and the most common RISHN location was the sinonasal region. Osteosarcoma was the principal histology, followed by fibrosarcoma. Surgery was the most frequently applied treatment modality. Of all patients with RISHN, 40.7% died of this disease after a mean interval of 13.9 months. Conclusions Notwithstanding the increased use of RT, the number of reported RISHNs has not increased substantially during the past two decades. Surgery with wide margins forms the best therapeutic option for these cases, but the outcome remains poor.

Radiation-Induced Sarcoma of the Head and Neck Following Radiotherapy for Nasopharyngeal Carcinoma: A Single Institutional Experience and Literature Review

“…The frequency of RIS is very low, which makes it difficult to conduct systematic reviews. However, several systematic reviews have been published recently ( 22 – 25 ). It had been reported that the incidence of RIS is between 0.03 and 0.8% in the early-stage ( 26 ).…”

“…Recently different systematic reviews and cohort studies have been conducted on the frequency and clinical features of RIS in the neck and head cancer after RT. The main findings of these studies can be summarized as follows ( 22 , 24 , 25 , 32 , 36 – 39 ).…”

Radiation-induced undifferentiated spindle cell sarcoma following high-dose-rate interstitial brachytherapy for tongue squamous cell carcinoma

“…Although both sarcoma and a pseudo-tumor can be induced by radiation, it remains unclear whether a pseudo-tumor represents the precursor stage of a sarcoma [ 14 ]. A literature review of radiation-induced sarcoma showed that median age at diagnosis of radiation-induced sarcomas of the head and neck was 52 years (inter-quartile range, 21.5 years), with a mean latency between initial radiation therapy treatment and diagnosis of 11.1 years (range, 1.3-38 years) noted in one study [ 5 ], and 11.5 years (range, 6-17 years) reported by another [ 9 ].…”

“…Those occurring early during irradiation for oral cancer treatment include stomatitis and taste disorders, while late side effects include soft-tissue ulcers and osteonecrosis [ 4 ]. However, radiation-induced malignancy is probably the most serious complication affecting long-term survivors [ 5 ]. There is no consensus definition of radiation-induced malignancy, but the most important point is to distinguish it from recurrence.…”

Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System

“…54 The most common types are osteosarcomas, fibrosarcomas, and malignant fibrous histiocytomas. 55,56…”