gms | German Medical Science

Radiation therapy is an indispensable part of curative treatment approaches in a variety of malignancies. One of the caveats of radiation is the risk of inducing secondary tumors decades later. Seventeen patients suffering from postirradiation sarcoma (PIS) were identified in the registry of the interdisciplinary sarcoma center at the Tuebingen University Medical Center within a 10 year period (1994 to 2004). The patients had received radiation therapy for breast cancer (n=6), lymphoma (n=6), cancer of the female reproductive organs (n=2), head and neck cancer (n=2), and neuroblastoma (n=1). The arithmetic mean of delivered total radiation dose per patient was 48.76 Gy (range 35 to 72 Gy). On average the sarcomas were diagnosed 16.7 years (range 5.5 to 35.0 years) following initiation of irradiation. The tumors arose within the radiation field in 12 cases, on the border of the field in 3 cases, and out of field in 2 cases. The most common histologic subtype was pleomorphic sarcoma, not otherwise specified (n=6). At the time of diagnosis of the PIS, 9 patients presented with localized disease, 6 patients had metastases (no details available for the remaining 2 patients). 14 patients underwent surgery, either in curative or palliative intent. Clear surgical margins could be achieved in 8 cases. 4 patients received palliative chemotherapy, one patient suffering from osteosarcoma was treated with a neoadjuvant multiagent chemotherapy protocol (cooperative osteosarcoma study group COSS 96). 7 patients were treated with radiation mostly for osseous metastases in palliative intent. 5 patients are currently in complete remission between 2 and 18 months after diagnosis of the PIS. The remaining patients developed a relapse or disease progression. In view of the large number of patients being treated with radiation, the development of a PIS is a rare event. However, many patients are diagnosed with advanced disease. Only a minority of the patients can be cured. The lag period between initial treatment an development of the PIS lasting decades in some cases underlines the need to follow tumor patients in the long run and to alert the patients for this particular risk in order not to delay the diagnosis of these sequelae.