Radiation‐induced osteosarcomas of the calvarium and skull base

Abstract

BACKGROUND: Although a rare complication of ionizing radiation, radiation-induced osteosarcoma is now more frequently recognized as radiation therapy has become common and cancer survival has increased. To date, publications on radiation-induced osteosarcoma of the cranium are limited to a few small series and case reports. METHODS: Data from 175 patients with a history of sarcoma of the head at The University of Texas M. D. Anderson Cancer Center from 1975 to 2007 were reviewed to identify patients with radiation-induced osteosarcoma. The diagnostic criteria were: 1) osteosarcoma arose within the previously irradiated field; 2) new sarcoma was histologically distinct from the original neoplasm; 3) no evidence of new sarcoma at the time of radiation; and 4) distinct latency period could be recognized. Frequencies and descriptive statistics were obtained for the various characteristics under study. RESULTS: The authors identified 16 patients with radiation-induced osteosarcoma of the cranium at their institution. The average age at diagnosis was 35 years. The median latency period was 12.5 years. Nine patients had skull base tumors, and 7 had calvarial tumors. Of the 14 patients treated surgically, 86% developed local recurrence. The median survival time was 29 months, and the 5-year survival rate was 29.6%. CONCLUSIONS: The authors report the largest series of cranial radiation-induced osteosarcoma. Although radiation-induced osteosarcoma is an uncommon but dire complication of radiotherapy, its incidence will probably increase in the future as the frequency of radiation treatment and cancer survival increase. These tumors are locally aggressive, and despite aggressive surgical and medical management, they have a high rate of local recurrence and mortality. Cancer 2011;117:2120-6.

Osteosarcoma of the cranial vault and skull base in pediatric patients

“…4,9,12,15,18,22,24,27,33,41,42,45,46,50,52,56,58,62,64,66 Nine cases of cranial osteosarcoma secondary to prior therapeutic radiation have been reported in children, 2 involving tumors of the skull base and 7 involving tumors of the calvaria. 8,15,16,33,39,54,55 Four cases of metastatic cranial osteosarcoma have been reported: 3 cases of metastatic cranial osteosarcoma from primary long bone tumors (2 involving the calvaria and 1 involving the cranial base) 40,42,44 and 1 case of metastatic osteosarcoma to the cranial base with a history of radiotherapy, in the context of multifocal disease. 55 The mean age of the pediatric patients with cranial osteosarcoma was 12.2 years and was similar in patients with calvarial and skull base tumors (12.6 and 11.6 years, respectively).…”

“…38 Tumors arising secondary to a pathological process are typically more aggressive and have higher recurrence rates than those arising de novo. 54,59 Malignancy resulting from these predisposing factors is also more likely to appear at a more advanced age, 32 contributing to the low incidence of cranial osteosarcoma in the pediatric population. 32,33,59 Traumatic injury has also been implicated in the development of osteosarcoma.…”

Squash Cytology of a Dural-Based High-Grade Chondrosarcoma May Mimic That of Glioblastoma in the Central Nervous System

“…At a first glance, the cytologic differential diagnoses of the present case showing highly pleomorphic cells and an abundant chondromyxoid matrix as well as a necrotic dirty background are as follows: glioblastoma, gliosarcoma, chondrosarcoma, chondroblastic osteosarcoma, other dedifferentiated primary or metastatic sarcoma [6,7,8,9,10,11]. The differential diagnosis from other more commonly encountered CNS tumors may be challenging.…”

High-grade myxofibrosarcoma presenting at the spermatic cord after radiotherapy for prostate cancer

“…Earlier literature characterises postradiation bone sarcomas much better than their soft-tissue counterparts because of their more common occurrence in the era of orthovoltage radiotherapy, since this frequency is absorbed more quickly by bone than by soft tissues 9. A wide range of therapeutic doses (8 to >60 Gy) have been reported to result in a postradiation sarcoma9; the majority of cases received a median of about 50 Gy 9 10.…”

“…A wide range of therapeutic doses (8 to >60 Gy) have been reported to result in a postradiation sarcoma9; the majority of cases received a median of about 50 Gy 9 10. In a review of secondary malignancies after Ewing's sarcoma, Kuttesh et al found no secondary sarcomas in patients receiving <48 Gy, compared to an absolute risk of 130 cases per 10 000 person-years of observation among patients who had received ≥60 Gy, suggesting dose dependence 9–12…”