Radiation-Induced Sarcoma: A Challenge for the Surgeon

Thijssens, Katja M. J.; Ginkel, Robert J. van; Suurmeijer, Albert; Pras, Elisabeth; Graaf, Winette T.A. van der; Hollander, M.H.J.; Hoekstra, Harald J.

doi:10.1245/aso.2005.03.041

Cited by 60 publications

(57 citation statements)

References 27 publications

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“…Recent studies [24,32] suggest that, with early diagnosis and aggressive medical and surgical treatment strategies, such as those adopted in our study, the survival rate of patients suffering from "secondary" sarcomas can approach that of primary sarcomas, describing a median survival of 12 months [24,32], which is similar to that observed in our study.…”

Section: Discussionsupporting

confidence: 88%

Post-radiation pelvic sarcomas after radiotherapy treatment of prostate adenocarcinoma

López-Torres¹,

Calvo-Haro²,

Mediavilla-Santos³

et al. 2018

Arch Clin Exp Surg

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Section: Discussionsupporting

confidence: 88%

Post-radiation pelvic sarcomas after radiotherapy treatment of prostate adenocarcinoma

López-Torres¹,

Calvo-Haro²,

Mediavilla-Santos³

et al. 2018

Arch Clin Exp Surg

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“…7 Similarly, RT-induced sarcomas are typically high-grade, with a tendency toward distant metastasis and local recurrence following resection. 8 The risk of secondary malignancy following RT is related to overall survival time. Travis et al showed that the relative risk of a second malignancy in survivors of testicular cancer is inversely correlated with age at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Multiple secondary malignancies following radiation therapy for testicular cancer

Neufeld

Kroczak

Drachenberg

2015

CUAJ

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Testicular germ cell tumours (TGCT) are a rare malignancy that affect primarily young men. We present an interesting case of nonseminoma testicular cancer treated with external beam radiation therapy (RT), which subsequently resulted in two separate secondary malignancies decades after initial treatment. Case reportAt the age of 16, the patient underwent surgical correction of bilateral undescended testicles. Ten years later, he was found to have a left testicular mass and underwent a left radical inguinal orchiectomy revealing a malignant teratoma. Surgery and 25 rounds of adjuvant RT resulted in cure. He has been managed uneventfully with testosterone throughout his adult life due to an atrophic right testicle.Forty four (44) years after orchiectomy and RT, the patient presented to the emergency department with gross hematuria and flank pain. A computed tomography (CT) scan was performed, demonstrating a 2.8 x 1.7 cm mass in the renal pelvis consistent with urothelial carcinoma, and a small pulmonary nodule was noted in the lower right lung. Cystoscopy revealed no evidence of lower tract pathology. The patient underwent a laparoscopic left radical nephroureterectomy and retroperitoneal lymph node dissection with endoscopic bladder cuff excision. Pathology revealed a pT1b, N1, MX, high-grade urothelial tumour with focal necrosis. Three of 11 nodes were positive for urothelial carcinoma; lymphovascular invasion was not noted.In light of the poor prognosis and high risk of recurrence, adjuvant chemotherapy of cisplatin/gemtabicine was offered, but was declined by the patient. The patient recovered quite well apart from noting intermittent hematochezia that began approximately 10 weeks after his surgery. Follow up CT scan performed two months after surgery identified enlargement of the small pulmonary nodule from 5 to 8 mm, along with a new 6 mm nodule. A soft tissue mass at the recto-sigmoid junction measuring 2.2 x 2.2 cm was also identified. Potential treatment options were discussed with the patient, including the fact that worsening findings on subsequent scans would preclude surgical management.The pulmonary and rectal lesions were identified again three months later. At this time, diffuse thickening of the psoas muscle at the level of the left renal bed and suspicious aortocaval and para-aortic lymph nodes were also noted. Colonoscopy identified a 7 cm mass approximately 7 cm from the anus consistent with leiomyosarcoma. Positron emission tomography (PET) scan identified diffuse disease, including the left psoas and pulmonary nodules, as well as cervical and para-aortic lymph nodes. It was unclear whether the lymph nodes and pulmonary nodules represented metastasis from an urothelial or mesenchymal tumour.The patient was averse to any kind of colostomy and would only consent to anterior resection of the tumour. The patient underwent laparascopic biopsy of a single retroperitoneal lymph node that identified metastatic urothelial carcinoma. The procedure was then converted to an open laparotomy and lo...

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“…Radical surgery (R0 resection) is possible in 50% to 75% of patients who have RAS located in any part of the body and results in 5-year local relapse-free survival rates of 34% to 46% and 5-year survival rates of 27% to 44%. 7,17,31,32 A review of all 92 patients of angiosarcoma after breast-conserving therapy reported in the English literature revealed that 55 of 75 patients (73%) with at least 1 year of follow-up developed a local recurrence after mastectomy (n ¼ 72) or wide local excision (n ¼ 3). 33 In that review, all patients who received adjuvant radiotherapy (n ¼ 1) and/or chemotherapy (n ¼ 3) experienced a local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Reirradiation and hyperthermia for radiation‐associated sarcoma

Jong

Oldenborg

Oei

et al. 2011

Cancer

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BACKGROUND:The objective of this study was to evaluate the role of reirradiation and hyperthermia in the treatment of radiation-associated sarcoma (RAS) in the thoracic region, which is an increasing, yet extremely rare condition with a poor prognosis. METHODS: Between 1979 and 2009, 16 patients with RAS in the thoracic region were treated in the Academic Medical Center and the Institute Verbeeten with reirradiation and hyperthermia. In 13 patients, this treatment was given for unresectable disease and 3 times after resection as adjuvant treatment. The median latency period between the original malignancy diagnosis and the RAS diagnosis was 86 months (range 19-212 months). Histology was angiosarcoma in 11 patients (69%). The literature on reirradiation with or without hyperthermia for RAS was reviewed. RESULTS: The median survival was 15.5 months (range, 3-204 months). Four patients were not evaluable for response. The response rate for the remaining 12 patients was 75% (7 complete responses and 2 partial responses). Six patients remained free of local failure until death (5 months and 7 months) or last follow-up (8 months, 11 months, 39 months, and 68 months). CONCLUSIONS: The current study indicates that combined reirradiation and hyperthermia for RAS in the thoracic region is feasible. The high response rate and the possibility of durable local control suggest that this treatment is promising. Cancer 2012;118:180-

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Radiation-Induced Sarcoma: A Challenge for the Surgeon

Cited by 60 publications

References 27 publications

Post-radiation pelvic sarcomas after radiotherapy treatment of prostate adenocarcinoma

Post-radiation pelvic sarcomas after radiotherapy treatment of prostate adenocarcinoma

Multiple secondary malignancies following radiation therapy for testicular cancer

Reirradiation and hyperthermia for radiation‐associated sarcoma

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