51
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Andreiuolo F, Calderaro J, Loriot Y, Bonvalot S, Chami L, le Cesne A, Forget S, Mathieu MC, Suciu V, Terrier P, Vielh P. KIT expression in postradiation sarcoma. Cytopathology 2009; 21:279-80. [PMID: 19863616 DOI: 10.1111/j.1365-2303.2009.00715.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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52
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Tardío JC, Nájera L, Alemany I, Martín T, Castaño A, Pérez-Regadera JF. Rectal angiosarcoma after adjuvant chemoradiotherapy for adenocarcinoma of the rectum. J Clin Oncol 2009; 27:e116-7. [PMID: 19667271 DOI: 10.1200/jco.2008.21.1979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
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53
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Fuchs B, Hoekzema N, Larson DR, Inwards CY, Sim FH. Osteosarcoma of the pelvis: outcome analysis of surgical treatment. Clin Orthop Relat Res 2009; 467:510-8. [PMID: 18855090 PMCID: PMC2628496 DOI: 10.1007/s11999-008-0495-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 08/20/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Risk factors to explain the poor survival of patients with osteosarcoma of the pelvis are poorly understood. Therefore, we attempted to identify factors affecting survival and development of local recurrence and metastasis. We retrospectively reviewed 43 patients who had high-grade pelvic tumors and were treated surgically. Twenty lesions were chondroblastic, 10 fibroblastic, 11 osteoblastic, and one each was giant cell-rich and small cell osteosarcomas. At a median of 3.5 years (range, 0.3-21 years) postoperatively, 13 patients were alive with no evidence of disease. The overall and disease-free 5-year survival rates were 38% and 29%, respectively, at 5 years. Anatomic location, tumor size, and margin predicted survival. Fifteen patients (35%) had local recurrence. The 5-year cumulative incidence of recurrence with death as a competing risk factor was 34%. Location in the ilium and size of the tumor predicted local recurrence. Twenty-one (49%) of 43 patients had metastases develop. The cumulative incidence of metastasis with death as a competing risk factor was 48% at 5 years. Six patients who presented with metastasis had a worse survival than patients who had no evidence of metastasis at presentation (2-year survival, 33% versus 76%). If distant metastasis is diagnosed subsequent to primary treatment, aggressive therapy may be justified. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bruno Fuchs
- Division of Orthopedic Oncology, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Nathan Hoekzema
- Division of Orthopedic Oncology, Mayo Clinic, Rochester, MN
USA
| | - Dirk R. Larson
- Department of Biostatistics, Mayo Clinic, Rochester, MN USA
| | | | - Franklin H. Sim
- Division of Orthopedic Oncology, Mayo Clinic, Rochester, MN
USA
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54
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Affiliation(s)
- Abigail Walton
- Palliative Care Hope Healthcare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Andrew L. Broadbent
- Palliative Care Hope Healthcare, Greenwich Hospital, Sydney, New South Wales, Australia
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55
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Weiner SJ, Neragi-Miandoab S. Pathogenesis of malignant pleural mesothelioma and the role of environmental and genetic factors. J Cancer Res Clin Oncol 2008; 135:15-27. [PMID: 18787841 DOI: 10.1007/s00432-008-0444-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor for which no effective therapy exists despite the discovery of many possible molecular and genetic targets. The late stage of MPM diagnosis and the long latency that exist between some exposures and diagnosis have made it difficult to comprehensively evaluate the role of risk factors and their downstream molecular effects. METHODS This manuscript is a review of current literature about the pathogenesis of malignant mesothelioma. In this overview, current published studies concerning pathogenesis of malignant mesothelioma are reviewed, with insights into its etiology and pathogenesis. We searched pubmed using the following subjects: mesothelioma, radiation, genetics, pediatric malignant mesothelioma, SV40 virus, and growth factors. We selected 350 valuable articles of which 152 sources were used to complete this review. CONCLUSION Many risk factors for MPM development have been recognized including environmental exposures, genetic susceptibility, viral contamination, and radiation. In this review, we discuss the current molecular and genetic contributors to MPM pathogenesis and the risk factors associated with these carcinogenic processes.
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Affiliation(s)
- Shoshana J Weiner
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH, USA
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56
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Agir H, MacKinnon C, Tan ST. Li-Fraumeni syndrome: a case with 4 separate primary sarcomas and 5 sequential free flaps in the maxillofacial region. J Oral Maxillofac Surg 2008; 66:1714-9. [PMID: 18634962 DOI: 10.1016/j.joms.2007.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 06/02/2007] [Accepted: 09/05/2007] [Indexed: 01/10/2023]
Affiliation(s)
- Hakan Agir
- Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
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57
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Markel DC, Mendelson SD, Yudelev M, Essner A, Yau SS, Wang A. The effect of neutron radiation on conventional and highly cross-linked ultrahigh-molecular-weight polyethylene wear. J Arthroplasty 2008; 23:732-5. [PMID: 18534543 DOI: 10.1016/j.arth.2007.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 06/18/2007] [Indexed: 02/01/2023] Open
Abstract
The effects of a sarcoma therapy dose level neutron radiation on oxidation and wear were compared between conventional (N2\Vac, Stryker Orthopedics, Mahwah, NJ) and highly cross-linked (Crossfire, Stryker Orthopedics) ultrahigh-molecular-weight polyethylene acetabular liners. Liners were exposed to 15 Gy, a typical sarcoma treatment dose. Wear testing was conducted on a hip simulator. Transvinylene and oxidation indices were measured to determine if significant radiolytic reactions and oxidation occurred after the neutron beam exposure. The neutron bombardment produced further oxidation in both N2\Vac and Crossfire liners. Surprisingly, neutron radiation caused 62% increase in wear for N2\Vac but 0% change for the Crossfire acetabular liners. This study suggested that when joint implants are exposed to neutron beam radiation therapy, the conventional polyethylene liner is at risk for rapid wear.
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Affiliation(s)
- David C Markel
- Department of Orthopedic Surgery, Providence Hospital and Wayne State University, Detroit, Michigan 48075, USA
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58
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Weiner SJ, Neragi-Miandoab S. Pathogenesis of malignant pleural mesothelioma and the role of environmental and genetic factors. J Carcinog 2008; 7:3. [PMID: 18662397 PMCID: PMC2507706 DOI: 10.1186/1477-3163-7-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 07/28/2008] [Indexed: 11/10/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare, aggressive tumor for which no effective therapy exists despite the discovery of many possible molecular and genetic targets. Many risk factors for MPM development have been recognized including environmental exposures, genetic susceptibility, viral contamination, and radiation. However, the late stage of MPM diagnosis and the long latency that exists between some exposures and diagnosis have made it difficult to comprehensively evaluate the role of risk factors and their downstream molecular effects. In this review, we discuss the current molecular and genetic contributors in MPM pathogenesis and the risk factors associated with these carcinogenic processes.
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Affiliation(s)
- Shoshana J Weiner
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Siyamek Neragi-Miandoab
- University Hospitals, Case Western Reserve University School of Medicine, 11100 Euclid Avenue LKS Building 7th floor, Cleveland, OH, USA
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59
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Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, Part 2. Skeletal Radiol 2007; 36:1017-27. [PMID: 17492444 DOI: 10.1007/s00256-007-0308-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 03/05/2007] [Accepted: 03/07/2007] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging plays an integral role in the detection and characterization of marrow lesions, planning for biopsy or surgery, and post-treatment follow-up. To evaluate findings in bone marrow on MR imaging, it is essential to understand the normal composition and distribution of bone marrow and the changes in marrow that occur with age, as well as the basis for the MR signals from marrow and the factors that affect those signals; these points have been reviewed and illustrated in part 1 of this two-part article. Part 2 will emphasize the practical application of MR imaging to facilitate differentiation of normal marrow, tumor, and treatment-related marrow changes in oncology patients, and will review complementary MR techniques under development.
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Affiliation(s)
- Sinchun Hwang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY 10021, USA
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60
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Kalra S, Grimer RJ, Spooner D, Carter SR, Tillman RM, Abudu A. Radiation-induced sarcomas of bone: factors that affect outcome. ACTA ACUST UNITED AC 2007; 89:808-13. [PMID: 17613509 DOI: 10.1302/0301-620x.89b6.18729] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We identified 42 patients who presented to our unit over a 27-year period with a secondary radiation-induced sarcoma of bone. We reviewed patient, tumour and treatment factors to identify those that affected outcome. The mean age of the patients at presentation was 45.6 years (10 to 84) and the mean latent interval between radiotherapy and diagnosis of the sarcoma was 17 years (4 to 50). The median dose of radiotherapy given was estimated at 50 Gy (mean 49; 20 to 66). There was no correlation between radiation dose and the time to development of a sarcoma. The pelvis was the most commonly affected site (14 patients (33%)). Breast cancer was the most common primary tumour (eight patients; 19%). Metastases were present at diagnosis of the sarcoma in nine patients (21.4%). Osteosarcoma was the most common diagnosis and occurred in 30 cases (71.4%). Treatment was by surgery and chemotherapy when indicated: 30 patients (71.4%) were treated with the intention to cure. The survival rate was 41% at five years for those treated with the intention to cure but in those treated palliatively the mean survival was only 8.8 months (2 to 22), and all had died by two years. The only factor found to be significant for survival was the ability to completely resect the tumour. Limb sarcomas had a better prognosis (66% survival at five years) than central ones (12% survival at five years) (p = 0.009). Radiation-induced sarcoma is a rare complication of radiotherapy. Both surgical and oncological treatment is likely to be compromised by the treatment received previously by the patient.
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Affiliation(s)
- S Kalra
- Royal Orthopaedic Hospital, Birmingham, England
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61
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Abbas SM, Hill AG. Prostatic sarcoma after treatment of rectal cancer. World J Surg Oncol 2007; 5:82. [PMID: 17663758 PMCID: PMC1950882 DOI: 10.1186/1477-7819-5-82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 07/30/2007] [Indexed: 01/21/2023] Open
Abstract
Background The relationship between radiation exposure for treatment of cancer and occurrence of a second primary cancer at the irradiated site is well known. This phenomenon is however rare in prostate. Case presentation A 75-year-old farmer was treated for rectal cancer with preoperative 45 Gy of radiotherapy and abdominoperineal resection. Four years later he developed symptoms of bladder outlet obstruction and acute urinary retention. He underwent a transurethral resection of the prostate. Histological examination of the removed prostate tissue and immunohistochemistry revealed it to be a poorly differentiated sarcoma. Conclusion We believe this to be the first reported case of radiation-induced sarcoma following radiotherapy treatment for rectal cancer. Since radiotherapy plays a pivotal role in the contemporary treatment of rectal adenocarcinoma, it is relevant to be aware of the potential long-term carcinogenic complications of radiotherapy of the pelvis.
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Affiliation(s)
- Salah M Abbas
- Department of Surgery, Middlemore Hospital, University of Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, Middlemore Hospital, University of Auckland, New Zealand
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62
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Tan A, Ngan SYK, Choong PFM. Post-radiation sarcoma of the neck treated with re-irradiation followed by wide excision. World J Surg Oncol 2006; 4:69. [PMID: 17018155 PMCID: PMC1592488 DOI: 10.1186/1477-7819-4-69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 10/04/2006] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Post-radiation sarcoma (PRS) is an uncommon disease manifesting as sarcoma in a previously irradiated field, usually with a latent period of 5 years or more. Literature is limited to small series. Optimal management of this disease is unclear. Positive margins are common following attempted curative surgery and outcomes are poor. Radiotherapy is hardly used and its effect on PRS is not known. We described a case of PRS treated with preoperative radiotherapy followed by margin-negative wide excision. CASE PRESENTATION The 59-year-old patient presented with a mass in the left supraclavicular fossa and numbness in the arm, six years following radical irradiation of the head and neck for nasopharyngeal carcinoma. Open biopsy showed pleomorphic spindle cell sarcoma. She was treated with pre-operative hyperfractionated radiotherapy followed by margin-negative wide excision and nerve grafting. Cumulative radiation dose to the supraclavicular fossa was 98 Gy. Histological examination of the post-irradiation tumor specimens showed evidence of significant tumor response to re-irradiation. The patient remained free of disease five years after surgery with excellent functional outcome. CONCLUSION Role of radiotherapy in PRS is uncertain. We described a case that was successfully managed with preoperative radiotherapy and margin-negative wide excision in terms of tumor control and functional outcomes. The impact of radiotherapy was demonstrated in the post-irradiation resected specimen. Further investigation using re-irradiation and surgery in PRS is warranted.
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Affiliation(s)
- Alex Tan
- Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Samuel YK Ngan
- Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
- The University of Melbourne, Parkville, Australia
| | - Peter FM Choong
- Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
- The University of Melbourne, Parkville, Australia
- Department of Orthopedic Surgery, St Vincent's Hospital, Melbourne, Australia
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63
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Shaheen M, Deheshi BM, Riad S, Werier J, Holt GE, Ferguson PC, Wunder JS. Prognosis of radiation-induced bone sarcoma is similar to primary osteosarcoma. Clin Orthop Relat Res 2006; 450:76-81. [PMID: 16906097 DOI: 10.1097/01.blo.0000229315.58878.c1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Radiation-induced sarcoma of bone (RISB) is thought to be associated with a poor prognosis. The purpose of this study was to determine disease-free and overall survival of patients treated for RISB, and whether there is a role for limb sparing surgery. Twenty-four patients had a mean latency of 16 years between radiation for their index cancer and RISB diagnosis. The most common tumor was osteosarcoma (n = 17). Ten patients with localized disease treated aggressively with chemotherapy and surgical resection had estimated 5-year disease-free and overall survival rates of 58% and 69% respectively. Patients treated by surgery alone or those with metastases at diagnosis had inferior outcomes. Patients who received a complete course of chemotherapy demonstrated better histologic tumor response and improved survival. There was no difference in survival between the limb sparing surgery (n = 12) or amputation (n = 8) groups. However, limb salvage patients had slightly higher rates of local tumor relapse and post-operative complications. Functional outcome following limb sparing surgery for 10 patients with RISB was similar to a matched cohort treated for primary osteosarcoma. An aggressive treatment approach for patients with RISB may provide similar rates of local recurrence and metastasis and functional outcomes compared to patients with primary osteosarcoma. LEVEL OF EVIDENCE Therapeutic study, level IV-1.
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Affiliation(s)
- Mahmood Shaheen
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada
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64
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Affiliation(s)
- Andrew Horvai
- Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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65
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Fangman WL, Cook JL. Postradiation Sarcoma: Case Report and Review of the Potential Complications of Therapeutic Ionizing Radiation. Dermatol Surg 2006. [DOI: 10.1111/j.1524-4725.2005.31815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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66
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Nakayama T, Tsuboyama T, Toguchida J, Tanaka C, Oya N, Hiraoka M, Nakamura T. Recurrence of osteosarcoma after intraoperative radiation therapy. Orthopedics 2005; 28:1195-7. [PMID: 16237885 DOI: 10.3928/0147-7447-20051001-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tomitaka Nakayama
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
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67
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68
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Morris CD, Antonescu CR. Lower extremity swelling after treatment for thigh synovial sarcoma. Clin Orthop Relat Res 2004:342-7. [PMID: 15577507 DOI: 10.1097/01.blo.0000150570.43192.7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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69
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Abstract
PURPOSE OF REVIEW This update addressing head and neck sarcoma presents new data published after January 2003. This new information is presented following review of contemporary management principles established before 2003. RECENT FINDINGS The application of advances in molecular and genetic techniques to characterize individual sarcomas has improved classification schemes and hopefully will lead to individually tailored therapy. Maturation and refinements of large tumor registries are permitting more detailed analysis of larger contemporary series of the rare head and neck sarcomas. Improved long-term survival of patients treated for sarcoma in their childhood has allowed study of the morbidity induced by treatment. Novel treatment strategies are under study to decrease morbidity without diminishing the chance for cure. SUMMARY Progress in improving the treatment of sarcoma of the head and neck has been slow due to the lack of a large clinical experience with this rare neoplasm. Advances continue and are anticipated to be most striking in the study of genetic mechanisms.
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Affiliation(s)
- Henry T Hoffman
- University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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70
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Klimek M, Kojs Z, Urbański K, Gruchała A, Miller G, Blecharz P. Mięsak popromienny trzonu macicy – opis przypadku. Rep Pract Oncol Radiother 2004. [DOI: 10.1016/s1507-1367(04)71042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
The multimodality treatment approach for patients with Ewing's sarcoma during the last decades has dramatically improved patient long-term survival. With improved survival, late consequences and morbidity associated with treatment have become apparent. Among the morbidity associated with treatment is the increased risk of development of secondary malignancies. Therefore, the purpose of the current study was to define the outcome of patients who had secondary malignancy develop subsequent to the diagnosis and treatment of Ewing's sarcoma. Of the 397 patients treated for Ewing's sarcoma at our institution during the past 25 years, 26 patients (6.5%) had 29 secondary malignancies develop. The mean age of the 13 males and 13 females averaged 16 years (range, 6-51 years), and the interval from the diagnosis of the Ewing's sarcoma to the development of the secondary malignancy averaged 9.5 years (range, 1-32.5 years). The secondary malignancies included eight hematopoietic cancers, 12 sarcomas, and nine carcinomas. Although carcinomas most likely represent the general risk of developing cancer in the healthy population, the sarcomas were caused by radiation therapy and the hematopoietic tumors caused by chemotherapy. The latter occurred at a mean latent period of 4.8 years (range, 1.7-12.9 years), and the sarcomas occurred after a mean of 10.9 years (range, 1.5-32.5 years). At the mean followup of 15 years (range, 2-33 years) from diagnosis of Ewing's sarcoma and at a mean followup of 5 years (range, 0.5-28 years) from diagnosis of the second malignancy, 14 patients are alive (43%); however, patients with either sarcomas or hematopoietic secondary malignancies had not only a significantly shorter interval from secondary malignancy to followup (3.3 and 1.2 years, respectively, versus 7.3 years), but also a more dismal prognosis (eight of 12 or six of eight patients died, respectively, versus one of nine). Although the risk of having secondary malignancy develop after the treatment of a Ewing's sarcoma may be only slightly greater than the risk compared with other childhood cancers, patients with hematopoietic and radiation-induced secondary malignancies have a detrimental prognosis. Patients with Ewing's sarcoma need to be followed up carefully and frequently.
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Affiliation(s)
- Bruno Fuchs
- Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA
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