Should Cancer Survivors Fear Radiation‐Induced Sarcomas?

Abstract

A bstractPurpose/Results. Ionizing radiation is carcinogenic and the induction of a second malignancy is a serious potential long-term complication of radiotherapy. The incidence of radiation-induced sarcomas was evaluated from many large epidemiological surveys of long-term cancer survivors reported in the literature over the past 30 years and only one case was found for every 1000 patients irradiated. D iscussion. Although greater numbers of cancer patients are receiving radical radiotherapy and surviving free of disease for longer intervals, cases of radiation-induced sarcomas are rare and should not deter patients from accepting radiotherapy as treatment for curable cancers. With improvements in the administration of radiotherapy over the past two decades which are resulting in less damage to bone and soft tissues, it is likely that fewer cases of this condition will be seen in the future. If these sarcomas are diagnosed early, long-term survival can be achieved with surgical excision and possibly re-irradiation, as occurs in other types of sarcomas.K ey w ords: radiation-induced sarcoma, bone sarcom a, soft tissue sarcom a.

Irradiation-induced bone sarcoma in a patient treated for cervix cancer 28 years earlier

“…[5] found that relative risk for bone sarcoma in the irradiated field was 3.0. The overall incidence of post-irradiation sarcoma ranged from 0.03% after 10 years to 0.8% after 30 years [15, 17–19]. …”

Radiotherapy for Rodent Ulcer Type of Basal Cell Carcinoma

“…The most common acute adverse events associated with radiotherapy include erythema and desquamation 2 . Although the presence of telangiectasias and hypopigmentation account for the majority of late side effects, there is a low risk of radiation‐induced malignancy that can occur years after the initial exposure 5 . Moreover, the risk of radiation‐induced malignancy would be substantially lower than the risk of death resulting from the general anesthesia administered during resection and reconstruction of an advanced basal cell carcinoma.…”

“…2 Although the presence of telangiectasias and hypopigmentation account for the majority of late side effects, there is a low risk of radiation-induced malignancy that can occur years after the initial exposure. 5 Moreover, the risk of radiation-induced malignancy would be substantially lower than the risk of death resulting from the general anesthesia administered during resection and reconstruction of an advanced basal cell carcinoma. The true 5-year recurrence rate after radiotherapy for basal cell carcinoma is difficult to determine as many studies do not distinguish between histologic subtypes and initial tumor size.…”

p53 status in radiation-induced soft-tissue sarcomas

“…A rise of radiationinduced malignancies is an infrequent (about 0.03%) [17] but well-recognized outcome after radiation treatment [21,26,27,30] and has been described for atomic bomb survivors [25] and Chernobyl survivors [23]. At most, 5% of all second primary cancers can be convincingly linked to the radiation treatment and about 0.1% of radiotherapy patients developed sarcomas (reviewed in [7]). Occurrence of radiation-induced sarcomas is reported relatively often in the literature [10,27] (reviewed in [16]).…”