Clinicopathologic features and treatment of postirradiation sarcoma of bone and soft tissue

• Published in: Journal of surgical oncology 2000-09, Vol.75 (1), p.42-50
• Main Authors: Inoue, Yoshiya Z., Frassica, Frank J., Sim, Franklin H., Unni, K. Krishnan, Petersen, Ivy A., McLeod, Richard A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amputation; Biological and medical sciences; Bone Neoplasms - pathology; Bone Neoplasms - surgery; carcinoma; Child; Child, Preschool; Diseases of the osteoarticular system; Female; Humans; Infant; local recurrence rate; Male; management; Medical sciences; Middle Aged; Neoplasms, Radiation-Induced - pathology; Neoplasms, Radiation-Induced - surgery; Prognosis; Radiation therapy and radiosensitizing agent; Radiotherapy - adverse effects; retrospective review; Retrospective Studies; Sarcoma - pathology; Sarcoma - surgery; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - surgery; survival rate; Treatment with physical agents; Treatment. General aspects; Tumors; Tumors of striated muscle and skeleton
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/1096-9098(200009)75:1<42::AID-JSO8>3.0.CO;2-G

Background and Objectives An analysis of the clinicopathologic features and treatment of patients with postirradiation sarcoma of bone and soft tissue was performed to guide modern evaluation and management. Methods A retrospective analysis of 135 sarcomas in 130 patients was performed. Results The mean age of the 130 patients was 48 years, and there was a female predominance because of irradiation for carcinomas of the breast and uterus. Indication for irradiation was a soft tissue lesion (such as lymphoma or breast cancer) in 58.5% of patients and a bone lesion (such as giant cell tumor or fibrous dysplasia) in 41.5%. The latent period (interval between irradiation and discovery of the sarcoma) ranged from 4–55 years (mean, 17 years). Of the lesions, 74% were stage IIB (high‐grade extra‐compartmental) and 24% were stage III (metastases). Ninety‐four patients received their treatment at our institution. Of the 61 patients with resectable disease, 49 had amputations and 12 had limb salvage procedures. The 5‐year cumulative survival rate was 68.2% for patients with peripheral (extremities, including proximal femur and hip) resectable lesions and 27.3% for patients with central (pelvis, head/neck, and ribs) resectable lesions. The local recurrence rate correlated with the surgical margin achieved: intralesional, 73%, marginal, 64%, and wide, 23%. Conclusions The prognosis for patients with peripheral resectable postirradiation sarcomas is good if a wide surgical margin can be achieved. This group of patients should be treated aggressively because they have a new cancer. J. Surg. Oncol. 2000;75:42–50. © 2000 Wiley‐Liss, Inc.