Radiation-induced osteosarcoma following treatment of Ewing's sarcoma

Abstract

Radiation-induced sarcomas are a known, rare, complication from prior therapeutic radiation therapy. Radiation-induced sarcomas have been reported to have poor associated prognoses with increased morbidity and mortality when compared to primary sarcomas. In this case report, we discuss a 27-year-old female who presented at the age of 17 during pregnancy with an inability to bear weight and was subsequently diagnosed with Ewing's sarcoma of her femur. Adequate response to treatment was obtained with the initial treatment and the patient represented with acute, severe pain of her femur at the site of prior Ewing's. Extensive workup demonstrated radiation-induced osteosarcoma at the site of her prior Ewing's sarcoma in the radiation field. Multidisciplinary teams including orthopedics, pathology, medical oncology, and radiology are vital for appropriate and efficacious diagnosis of radiation-induced sarcomas. Despite the rarity of radiation-induced sarcoma, the ability to recognize and diagnose recurrent sarcoma is important for radiologists, particularly considering the associated poor prognosis. Early diagnosis and aggressive multidisciplinary treatment is crucial to improving patient morbidity and mortality. In this case, the diagnosis of radiation-induced osteosarcoma allowed expedited workup and initial aggressive, lifesaving treatment for our patient.

Secondary Osteosarcoma of the Femur Following Radiotherapy for Ewing’s Sarcoma

“…Surgical intervention with negative margins is the most important factor affecting long-term survival in patients with radiation-induced sarcoma. [ 4 ] Prosthesis reconstruction is necessary following segmental tumor resection for maintaining good limb function.…”

“…[ 3 ] Radiation-induced sarcoma is associated with a grave prognosis and increased morbidity when compared to primary osteosarcomas. [ 4 ]…”

Osteosarcoma of the Humerus Developing as Second Malignancy in the Irradiation Field Outside the Primary Tumor: 11 Years after Ewing Sarcoma of the Scapula and 29 Years after Breast Cancer

“…Ewing sarcoma it can be assumed that they developed within the affected bone treated by irradiation [15]. When confronted with abnormal musculoskeletal findings developing after treatment of primary tumors biopsy needs to be generously considered [16] especially considering the low risk of percutaneous biopsy [17].…”

Osteosarcoma in Pediatric and Adult Populations: Are Adults Just Big Kids?

“…Previous radiation exposure is another cause of secondary osteosarcoma in adults, often occurring many years after the radiation was delivered [40,41]. Osteosarcoma is the most common radiation-induced bone tumor, representing 50-60% of cases [42].…”

“…Osteosarcoma is the most common radiation-induced bone tumor, representing 50-60% of cases [42]. Radiationinduced bone sarcomas are associated with increased morbidity and mortality compared with primary bone tumors [41,43]. Radiation-induced osteosarcoma is associated with a 50% lower 5-year overall survival when compared to primary cases of osteosarcoma [44].…”