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During the period 1931 to 1970, 50 cases of radiation‐induced osteogenic sarcoma were seen at the Memorial and James Ewing Hospitals. Twenty‐two of these cases had previously been described; the present paper adds an additional 28 cases to the existing series and reviews those factors related to the development of neoplastic changes. In 35 patients, there was evidence of preexisting bone pathology in the form of benign osseous growths. Fifteen patients had soft‐part and visceral neoplasms, such as retinoblastoma, seminoma, and breast carcinoma, the involved bone lying in the pathway of the radiation beam. Symptoms ranged from a palpable tender mass in the involved bone to intestinal obstruction secondary to metastatic radiation‐induced osteogenic sarcoma. Essentially all bones in the skeletal system appear to have been vulnerable. The radiation dosages ranged from 1,200 rads given in a few weeks to 24,000 rads given in 2 years. Induction time covered a period of 4 through 30 years with a mean of 9 years. Thirty‐two of the patients developing this neoplasm have since died of their disease.

The clinical histories of 46 cases of chordoma seen and treated at Memorial Hospital from 1930 to 1965 are reviewed, including 30 cases of sacral origin, ten cases of vertebral origin, five sphenoidal and one extranotochordal, with an age range from 2 1/2 years to 71 and a male sex predominance of 32 to 14. Only three patients in this series are alive and free of disease 5, 13 and 16 years after diagnosis and treatment and the absolute 5‐year survival rate with freedom from disease is only 8.7%. Complete surgical excision can result in a cure in a few selected sacrococcygeal or sphenoidal cases but incomplete removal or tumor spillage in the wound are certain to lead to recurrence and probable metastasis and death. When radiation therapy is employed, either alone or preoperatively, symptomatic relief can be expected and some regression in the tumor at least for a time. In those tumors that show some radioresponsiveness repeat x‐ray dosages may prove of extended benefit. The authors conclude that distant metastasis and local recurrence are more common than ordinarily considered and therapeutic doses of supervoltage irradiation pre‐ or postoperatively could be of subtantial benefit in the management of this uncommon disease.

Sixty‐six patients with well‐documented osteogenic sarcomas arising in bones and soft tissues after exposure to x‐rays, which represent approximately 5.5 percent of all osteogenic sarcomas registered since 1921 at this institution, were studied. These secondary sarcomas occurred in equal proportion in both sexes, with the sixth decade of life being the most common age. In 42 patients, the bone had been normal at the time of irradiation, whereas in 24, the radiation was directed against an osseous tumor or tumor‐like lesion. The median latent period was 10.5 years in both groups, ranging from 3.5 to 33 years. The radiation varied from diagnostic quality to 1 MeV x‐rays. The dose was variable, but none was less than 2000 rads. Postradiation osteogenic sarcomas most commonly arose in the bones of the pelvic and shoulder regions. Histologically, the sarcomas were mostly of the fibrous type (46%) and radiographically showed a destructive bone lesion with or without signs of radiation osteitis. The cumulative disease‐free survival rate at 5 years was 17%, with a median survival estimate of 1 year. Cancer 55:1244‐1255, 1985.