Radiation-induced sarcomas of the head and neck in post-radiation nasopharyngeal carcinoma

Abstract

common, with a crude incidence in adults of less than 0.5 % in various situations [1][2][3][4][5]. With improved patient survival [6][7][8], RIS is likely to be encountered more frequently. It is now generally believed that complete surgical resection of RIS provides the only chance of a cure [3,4]. Unfortunately, the reported prognosis is poor owing to advanced RIS at diagnosis [3,4,9]. RIS has become a critical problem that can limit long-term survival and hinder quality of life. To detect an RIS at an earlier stage, the radiologist should be aware of the common radiological appearances, which can be scrutinized on follow-up scans.The purpose of this study was to document the clinical findings and the radiological features on computed tomography (CT) and magnetic resonance imaging (MRI) of RIS in the head and neck following RT for NPC. Materials and methods PatientsThe institutional ethics review board approved this retrospective study and waived the need for informed consent. Patients with RIS in the head and neck following RT for NPC identified from a review of the histological and radiological results from December 1998 to September 2012 met the inclusion criteria. The clinical records were reviewed to determine histology, latency period, clinical presentation and treatment. The diagnostic criteria of patients with RIS was based on the criteria published by Cahan et al. [10]: a prior history of RT; the occurrence of a sarcoma within the previously irradiated field; a latency between irradiation and the second primary sarcoma of at least 3 years; histologically proven sarcoma arising within the irradiated field. One of the co-authors engaged in the pathological

Oral radiation‐induced sarcomas: Systematic review

“…In previous studies, researchers have observed that this lesion in the head and neck is mainly found in the fifth decade of life. 7,10,19 We found a mean age of 50 years old, with a higher age among males than females. The tumors also showed a male predilection, consistent with previous studies.…”

“…The tumors also showed a male predilection, consistent with previous studies. 7,10 RISOC primary lesions most commonly affected the nasopharynx and tongue. 4,5,10,20 These entities demonstrated a mean time to diagnosis of 2.4 months and a mean tumor size of 2.6 cm, consistent with previous literature.…”

“…Previous studies demonstrated a latency time varying from 120 to 158 months. 7,11,22 Clinically, lesions were presented as a painful swelling and also showed numbness and paresthesia in a few cases. 3,24 RISOC were mostly seen in the mandible (47.5%) and maxilla (36%), consistent with previous studies.…”

“…After irradiating a giant-cell tumor in the shoulder, an RIS osteosarcoma was developed one and half years later. 5,6 In previous literature, some reports published RIS in the nasopharynx, 7 spine, 8 breast, 9 and external auditory canal. 10 Radiation-induced sarcoma of the oral cavity (RISOC) is an uncommon tumor.…”

Head and Neck Radiation-Induced Sarcoma: Report of Two Cases

“…The incidence of radiation-induced sarcoma (RIS) ranges from 0.03 to 0.3% and the most common location was the maxillary region, including the maxillary sinus, alveolar process, palate, and adjacent nasal cavity [2,4] RIS developed within the radiation volume for the primary tumour in which the mean radiation dose for the primary tumour was 33 Gy (range: 25-50Gy); the mean latency period between radiation therapy and occurrence of the sarcoma was 15 years (range of 3-50 years) [5] For bone sarcomas Cahan et al has developed the first set criteria for RIS [6] Murray et al revised these to include other soft tissue sarcomas [7] These criteria was further modified as such: (i) a prior history of radiation; (ii) development of a sarcoma in the field of radiation; (iii) a latency period of at least 2 years between radiation and appearance of the sarcoma and (iv) evidence that the sarcoma is histologically different from the irradiated primary cancer [8] The average latency period from the time-of-radiation to the time-of-diagnosis of the RIS was 12.6 years (range of 3-30 years) and it was believed that squamous cell carcinoma will be presented at a mean duration of 12.5 years post radiation. Sarcomas will be presented a bit sooner, around 8.8 years post radiation.…”