Malignant fibrous histiocytoma of maxilla following radiotherapy for bilateral retinoblastoma

Two Cases of Secondary Sotf Tissue Sarcomas after Radiotherapy and Radiochemotherapy

Background

The development of secondary soft tissue sarcomas after chemo-radiotherapy is a rare and little known event, but its frequency is increasing.

Patients and Methods

We report two cases of secondary soft tissue sarcomas. The first is the case of a 51-year-old woman treated for Hodgkin's disease with chemotherapy and radiotherapy 15 years before she developed a high-grade malignant pleural sarcoma. The patient had no history of asbestos exposure. The second is the case of a 64-year-old woman with a giant cell malignant histiocytoma secondary to colorectal cancer treated with surgery and radiotherapy nine years before. The patients were not eligible for surgery or radiotherapy. Both were treated with chemotherapy (ifosfamide and epirubicin) without any relevant secondary effects; however, the response to therapy was poor.

Conclusions

The causes of secondary malignancies are multifactorial, but radiation therapy and chemotherapy are certainly implicated in the development of post-therapy neoplasms that are difficult to treat.

High-dose chemotherapy followed by stem cell transplantation in the management of retinoblastoma: a systematic review

BACKGROUND AND OBJECTIVES

In recent years, there has been an increasing role for stem cell transplantation in the management of retinoblastoma. The aim of this study was to systematically review the role high-dose chemotherapy followed by stem cell transplantation in the treatment of patients with metastatic or relapsed, trilateral or bilateral advanced retinoblastoma, and in patients with tumor at the surgical margin of the optic nerve and/or extrascleral extension.

DESIGN

Systematic literature review.

METHODS

We performed an extensive PubMed database search on 25 February 2012 for studies describing the use of high-dose chemotherapy followed by stem cell transplantation in the management of patients with retinoblastoma.

RESULTS

We located 15 studies that met the inclusion criteria and that included 101 patients. Following treatment for metastatic and relapsed disease, 44 of 77 patients (57.1%) were alive with no evidence of disease at the time of follow-up. However, a higher rate of local relapse developed in patients with CNS metastases (73.1%), which dropped to 47.1% in patients who received thiotepa. In patients with trilateral or bilateral advanced retinoblastoma, 5 of 7 (71.4%) with reported outcome data were alive with no evidence of disease at the time of follow-up. In patients with tumor at the surgical margin of the optic nerve and/or extrascleral extension, 6 of 7 patients (85.7%) were alive with no evidence of disease at the time of follow-up.

CONCLUSIONS

Durable tumor control is possible in patients with non-CNS metastases, trilateral or bilateral advanced retinoblastoma, and in patients with tumor at the surgical margin of the optic nerve and/or extrascleral extension. Patients with CNS metastases require thiotepa to improve tumor control.

Post-irradiation leiomyosarcoma of the maxilla: Report of a case in a patient with prior radiation treatment for retinoblastoma

Post-irradiation sarcoma is a well-defined complication of radiation therapy, yet few reports document such lesions in the head and neck. A 30-year-old man presented for evaluation of an expansile lesion of the left posterior maxilla. His medical history was significant for a childhood ocular malignancy - unilateral retinoblastoma - which was treated with a combination of surgical enucleation of the eye and external beam radiation therapy. Biopsy of his maxillary lesion revealed a spindle cell malignancy that was morphologically and immunohistochemically consistent with a diagnosis of leiomyosarcoma. Further investigation into the case revealed that the patient had three children, every one of whom developed unilateral retinoblastoma in infancy. Compared to the more frequent presentation of bilateral tumors in hereditary cases of retinoblastoma, such cases of heritable unilateral retinoblastoma are exceptional. Importantly, heritable forms of retinoblastoma confer a significant risk for development of second primary cancers, necessitating long-term clinical follow-up in these patients.

Oral post-radiation malignant fibrous histiocytoma: a clinicopathological study

Five cases of oral malignant fibrous histiocytoma (MFH) in patients who had previously received radiotherapy in the head or neck region were included in this study. There were 3 men and 2 women. Four patients had been irradiated for nasopharyngeal carcinoma (NPC) and the other for a squamous cell carcinoma (SCC) involving the tongue and mouth floor. The MFH developed 2.5-11 years after the initial radiotherapy. Two cases of MFH occurred in the maxilla, two in the mandible, and the remaining one in the tongue, floor of mouth and mandible. Clinically, the oral post-radiation MFH presented as tender, reddish, elastic, lobulated masses with surface ulceration. Radiographic examination of the involved jaws revealed a poorly defined radiolucent lesion without any periosteal or endosteal reaction. The prognosis of these tumors was very poor. Although aggressive multimodality treatment had been applied, 3 of 5 patients eventually died of the disease, with a mean survival time of 17 months after establishing the diagnosis of MFH. In order to ensure the early diagnosis and treatment of this radiation-induced second malignancy, close oral follow-up is mandatory for patients who have received radiotherapy for head and neck malignancies.

Malignant fibrous histiocytoma: a report of two cases arising in sites of previous irradiation

This report illustrates two cases of malignant fibrous histiocytoma of the maxilla arising in sites which had been irradiated. The prognosis for such tumours in the jaws appears to be very poor.