The clinical and functional outcome for patients with radiation‐induced soft tissue sarcoma

Abstract

BACKGROUND: Radiation-induced soft tissue sarcomas (RI-STS) are rare, and it is believed that they are associated with a poor prognosis. The authors of this report compared the clinical and functional outcomes of adults who had extremity RI-STS with the outcomes of adults with sporadic STS. METHODS: Forty-four patients who were diagnosed with RI-STS from 1989 to 2009 were identified from 4 prospectively collected databases. Patient demographics, surgical and adjuvant treatment parameters, and oncologic and functional outcomes were evaluated. RESULTS: The median latent period from irradiation of the primary condition to RI-STS diagnosis was 16 years. The median radiotherapy dose used for the index condition was 45 gray. The median age at RI-STS diagnosis was 56 years. The most common primary diagnoses were breast cancer (36.4%) and lymphoma (34.1%). The most common RI-STS histologies were malignant fibrous histiocytoma (36.4%) and angiosarcoma (18.2%). Forty-two patients underwent surgery, 13 patients received adjuvant radiotherapy, and 8 patients received adjuvant chemotherapy. Systemic metastases occurred in 50% of treated patients (n ¼ 21), and 26% (n ¼ 11) developed local recurrence, the risk of which was lower among patients who received reirradiation (P ¼ .043). The 5-year disease-free interval (DFI) and overall survival (OS) rates for patients with RI-STS who presented without metastasis were 36% and 44%, respectively. Patients who had International Union Against Cancer TNM stage III RI-STS had a significantly worse DFI compared with patients who had stage III sporadic STS (multivariate analysis, P ¼ .051). Eighteen patients with RI-STS underwent functional assessment after surgery, and their results were comparable to those of patients with sporadic STS. CONCLUSIONS: Despite aggressive surgical treatment, patients who have RI-STS remain at greater risk of both local and systemic recurrence compared with patients who have sporadic STS, but they can anticipate similar functional outcomes. Reirradiation can be relatively safe and effective if used properly. Cancer 2012;118:2682-

Soft Tissue Masses for the General Orthopedic Surgeon

“…36 Radiation-induced soft tissue sarcoma is associated with a higher risk of local recurrence and metastasis. 7 Bony invasion is uncommon and associated with increased mortality. 10 Older patients are at higher risk for recurrence of disease.…”

“…A history of radiation therapy is a known risk factor for developing a soft tissue sarcoma. 7 The patient should be screened for a personal or family history of genetic conditions associated with increased risk of developing soft tissue sarcomas. Li-Fraumeni syndrome is a germline mutation in tumor protein 53 that predisposes a patient to developing multiple cancers at a young age.…”

Post-radiation pelvic sarcomas after radiotherapy treatment of prostate adenocarcinoma

“…Recent studies have shown that doses above 30Gy are more closely correlated with the appearance of sarcoma. This was the dose received by 100% of our patients treated with radical radiotherapy for prostate adenocarcinoma [1,22]. Kalra et al [3], analyzing the latency time of post-radiation sarcomas, ruled out a correlation between radiation dose and latency period until the appearance of radiation-induced sarcoma.…”

Angiosarcoma in previously irradiated breast in patient with Li-Fraumeni syndrome. A case report

“…1,7,8,11 The rationale for using radiation as an adjuvant treatment for breast cancer is that residual cancer cells might remain after the primary treatment. However, even if radiation is used therapeutically, it causes damage to cell DNA, as also shown in Table 1.…”