Helen Q. Woodard

Radiation-induced soft-tissue and bone sarcoma.

From the records of Memorial Hospital of the past 50 years, 47 cases with an established diagnosis of radiation-induced sarcoma were identified and divided into two groups: the first included 20 cases of soft-tissue sarcoma arising from irradiated tissues, and the second comprised 27 cases of bone sarcoma arising from normal bones in the irradiated field. Medians for the latent periods from irradiation to diagnosis of bone and soft-tissue sarcoma were 11 and 12, years, respectively. In bone sarcomas, the latent period was longer after larger radiation doses and children appeared to be more susceptible to cancer induction than adults. Criteria for establishing the diagnosis of radiation-induced sarcoma and the magnitude of the risk of bone sarcoma are discussed.

Postradiation osteogenic sarcoma of bone and soft tissues : a clinicopathologic study of 66 patients

Sixty‐six patients with well‐documented osteogenic sarcomas arising in bones and soft tissues after exposure to x‐rays, which represent approximately 5.5 percent of all osteogenic sarcomas registered since 1921 at this institution, were studied. These secondary sarcomas occurred in equal proportion in both sexes, with the sixth decade of life being the most common age. In 42 patients, the bone had been normal at the time of irradiation, whereas in 24, the radiation was directed against an osseous tumor or tumor‐like lesion. The median latent period was 10.5 years in both groups, ranging from 3.5 to 33 years. The radiation varied from diagnostic quality to 1 MeV x‐rays. The dose was variable, but none was less than 2000 rads. Postradiation osteogenic sarcomas most commonly arose in the bones of the pelvic and shoulder regions. Histologically, the sarcomas were mostly of the fibrous type (46%) and radiographically showed a destructive bone lesion with or without signs of radiation osteitis. The cumulative disease‐free survival rate at 5 years was 17%, with a median survival estimate of 1 year. Cancer 55:1244‐1255, 1985.

Postradiation malignant fibrous histiocytoma of bone. A clinicopathologic study of 20 patients.

Among the 130 primary or secondary malignant fibrous histiocytomas of bone diagnosed and treated at Memorial Hospital for Cancer and Allied Diseases during the previous half century, 20 (15.4%) arose as a direct consequence of irradiation. This type is the commonest secondary osseous malignant fibrous histiocytoma at this institution. It affects the ilium, the scapula, and the distal end of the femur most frequently, predominantly in patients whose age peaks in the fifth decade of life, when their sarcomas developed. Grounds for the irradiation were either nonosseous conditions (13 patients) or preexistent skeletal lesions (seven patients). Reasons for the incidental bone irradiation included Hodgkins disease; carcinoma of cervix, breast, or lung; bilateral retinoblastoma, and others; giant cell tumors predominated among the irradiated skeletal lesions. The mean and the median radiation doses were 6,040 and 5,700 rads, respectively. The latent period between irradiation and the appearance of the bone sarcoma ranged from 4 to 47 years with a mean of 16.5 and a median of 14.5 years, respectively. The cumulative disease-free survival rate at 3 years was 58%. Although all patients who received their radiation therapy for a preexistent bone lesion survived, only 27% of patients whose bone was normal at the time of irradiation are alive and well at the 3-year mark.

Postradiation sarcomas of bone

Fifty-nine patients with osteogenic sarcomas arising in bones following exposure to x rays and 20 patients with postradiation malignant fibrous histiocytomas of bone arising as a direct consequence of irradiation were studied. These represent 5.5% of all osteogenic sarcomas and 4.9% of all malignant fibrous histiocytomas of bones. The sarcomas may affect any skeletal site, but most commonly they arose in bones of the pelvic and shoulder girdles or the distal end of the femur. Grounds for irradiation were either nonosseous conditions or preexistent skeletal lesions. Reasons for incidental osseous irradiation included Hodgkins disease, carcinoma of cervix, breast or lung; bilateral retinoblastoma and others, and giant cell tumor predominated among the irradiated skeletal lesions. The mean and the median radiation doses were 6,040 cGy (rad) and 5,700 cGy (rad), respectively. The period of latency between irradiation and the appearance of the bone sarcoma ranged from 3.5 to 47 y with a mean of 16.5 and median of 14.5, respectively. The cumulative disease-free survival rate for malignant fibrous histiocytoma patients at 3 y was 58%. The cumulative disease-free survival rate at 5 y for patients with osteogenic sarcoma was 17%, with a median survival estimate of 1 y. Although all patients with malignant fibrous histiocytoma who received their radiation therapy for a preexistent bone lesion survived, only 27% of the patients whose bone was normal at the time of irradiation are alive and well at the 3-y mark.

Hodgkin's Disease complicated by radiation sarcoma in bone

Seven patients after treatment of Hodgkins Disease who developed bone sarcomas in the radiation field were seen at this centre over the past eight years. Radiation-induced sarcoma in bone in patients with Hodgkins Disease is poorly documented. The large number of cases appeared to be an important new development and led to our review of all the patients with radiation-induced sarcomas (RIS) seen at this centre over the past 40 years. Thirty-seven patients with RIS in previously normal bone were found, and of these, only one patient with underlying Hodgkins Disease, who was seen here 27 years earlier. Hodgkins Disease and breast cancer were the most common primary underlying conditions and, as a result, the bones of the shoulder girdle were the commonest site of radiation-induced sarcoma. The clinical histories and radiographic findings of the eight patients with underlying Hodgkins Disease are discussed in detail.

Development of osteogenic sarcoma in a radium dial painter thirty-seven years after the end of exposure

Abstract A case of radiation-induced osteogenic sarcoma is reported in a fifty-five year old woman who had ingested radioactive paint between the ages of sixteen and eighteen years. Autoradiography of the bones of the amputated leg showed that radium was still concentrated at the sites of the former epiphyseal plates. The first sarcoma originated at one such site, and microscopic evidence of early sarcoma was found in at least one other. The patients total terminal body burden was about 0.8 μc. of radium. The accumulated dose in different microscopic areas of bone was estimated to range from 1,400 to 88,000 rads. There was roentgenographic evidence of radiation changes in almost the entire skeleton. Despite this, the patient had had few symptoms prior to the development of sarcoma.

Radiation-induced malignant tumors of bone in patients with Hodgkin's disease

Sixteen cases of radiogenic malignant bone tumors which developed in patients 4 to 31 y after they had received radiation therapy for Hodgkins disease are compared with 70 similar cases occurring after radiation exposure for other causes. No significant differences in age at irradiation, latent period, histology of tumors or radiographic characteristics were found between the Hodgkins cases and those of the comparison series. Fourteen of the 16 tumors in Hodgkins patients, or 87%, were diagnosed in the 15-y period between 1971 and 1985 in contrast to only 34% of the larger non-Hodgkins series. This difference appears significant and is associated with a doubling of the proportion of Hodgkins patients who are now living past the minimum latent period for such tumors. The median dose in the Hodgkins patients, 4000 cGy, is less than the 5100-cGy median in the other patients, and the range and protraction of the total doses are much less. In Hodgkins patients who have received total nodal irradiation, the volume of osseous tissue which is exposed may reach 25% of the total in the body. This is much greater than in most other treatment plans. Six of the Hodgkins patients received chemotherapy within a few months of irradiation; only three of 70 non-Hodgkins patients did so. All of the last factors may have modified the risk of radiation carcinogenesis in the Hodgkins patients but the data are not yet adequate for quantitation of the effect.