Not all sarcomas developed in irradiated tissue are necessarily radiation-induced – Spectrum of disease and treatment characteristics

Radiation-induced sarcoma masquerading as osteoradionecrosis: case report and literature review

“…However, these treatments have not been studied extensively and no conclusions can be made at this time. 7 In one study, the latency time for development of radiation-induced sarcoma ranged from 3 months to 53 years, with a mean time of 17 years. 5 Other studies have reported mean latency times of 12.9, 13 and 13.3 years.…”

“…12 The age at which radiation occurred is an important factor, with the risk being greater in children than in adults (3.6 per cent vs 0.7 per cent). 7 It appears that when chemotherapy is administered concurrently with radiation therapy, a synergistic effect occurs. The ratio of bone sarcoma incidence in irradiated tissue compared to the normal population after concurrent chemotherapy and radiotherapy was 113:1, versus 28:1 after chemotherapy alone and 19:1 after radiotherapy alone.…”

“…Radiationinduced sarcoma is currently treated using the accepted treatment protocols for primary osteosarcoma, with adjustments as needed based on individual cases. 5,7 In a retrospective case series of 80 radiation-induced sarcoma cases, the average survival rate for patients who underwent surgery was 48 months, compared with an average of 6 months for those who received chemotherapy alone. 14 Another study showed 63 per cent survival at five years for patients who had undergone complete excision; in contrast, the survival rate was only 10 per cent for patients in whom at least one surgical margin was not cleared of tumour.…”

“…7,11 Despite these criteria, the diagnosis can still be incorrect in up to 25 per cent of cases. 7 Patients with Li-Fraumeni syndrome, Von Recklinghausen's disease, and those that harbour mutations in tumour suppressor genes such as p53 and retinoblastoma are more likely to develop radiation-induced sarcoma. 9 Mertens et al reported that the most frequent mutations were alterations in chromosome 3p.…”

Head and neck soft-tissue sarcoma in adults

“…Diagnosis and causality are hard to establish, with criteria of progression over time; the terms "radiation-induced sarcoma" and "sarcoma in irradiated tissue" are a matter of discussion [8,9].…”