Laurino Simona, Omer Ludmila Carmen, Albano Francesco, Marino Graziella, Bianculli Antonella, Solazzo Angela Pia, Sgambato Alessandro, Falco Geppino, Russi Sabino, Bochicchio Anna Maria
Laboratory of Preclinical and Translational Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy.
Trial Office, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy.
Front Oncol. 2022 Sep 30;12:986123. doi: 10.3389/fonc.2022.986123. eCollection 2022.
The oncogenic effect of ionizing radiation is widely known. Sarcomas developing after radiation therapy (RT), termed "iatrogenic disease of success", represent a growing problem, since the advancements in cancer management and screening programs have increased the number of long-term cancer survivors. Although many patients have been treated with radiation therapy, only few data are available on radiation-induced sarcomas (RIS).
We examined the medical and radiological records of 186 patients with histologically proven soft tissue and bone sarcomas, which referred to IRCCS CROB Centro di Riferimento Oncologico della Basilicata from January 2009 to May 2022. Among them, seven patients received a histological diagnosis of secondary RIS, according to Cahan's criteria. Clinicopathological features and treatment follow-up data of RIS patients were retrospectively analyzed.
Among these secondary RIS, five arose in irradiated breast cancer (5/2,570, 0.19%) and two in irradiated head and neck cancer (2/1,986, 0.10%) patients, with a mean onset latency time of 7.3 years.The histology of RIS was one desmoid tumor, two angiosarcomas, one chondrosarcoma, two leiomyosarcomas, and one undifferentiated pleomorphic sarcoma. Out of the seven RIS, one received radiotherapy, one received electrochemotherapy (ECT), one received a second-line chemotherapy, three were subjected to three lines of chemotherapy, and one underwent radiofrequency ablation, chemotherapy, and ECT. Median survival time is 36 months. No significant survival differences were found stratifying patients for age at RT, latency time, and age at RIS diagnosis.
RIS represents a possible complication for long-survivor cancer patients. Therefore, adherence to a strict follow-up after the radiation treatment is recommended to allow early diagnosis and optimal management of RIS patients. After the planned follow-up period, considering the long-term risk to develop a RIS, a specific multispecialty survivorship care plan could be of benefit for patients.
电离辐射的致癌作用广为人知。放射治疗（RT）后发生的肉瘤，被称为“成功的医源性疾病”，正成为一个日益严重的问题，因为癌症管理和筛查项目的进步增加了长期癌症幸存者的数量。尽管许多患者接受了放射治疗，但关于辐射诱发肉瘤（RIS）的数据却很少。
我们检查了2009年1月至2022年5月转诊至IRCCS CROB巴斯利卡塔肿瘤参考中心的186例经组织学证实的软组织和骨肉瘤患者的医疗和放射学记录。其中，根据卡汉标准，7例患者获得了继发性RIS的组织学诊断。对RIS患者的临床病理特征和治疗随访数据进行回顾性分析。
在这些继发性RIS中，5例发生于接受过放疗的乳腺癌患者（5/2570，0.19%），2例发生于接受过放疗的头颈癌患者（2/1986，0.10%），平均发病潜伏期为7.3年。RIS的组织学类型为1例硬纤维瘤、2例血管肉瘤、1例软骨肉瘤、2例平滑肌肉瘤和1例未分化多形性肉瘤。7例RIS患者中，1例接受了放疗，1例接受了电化学疗法（ECT），1例接受了二线化疗，3例接受了三线化疗，1例接受了射频消融、化疗和ECT。中位生存时间为36个月。按放疗时年龄、潜伏期和RIS诊断时年龄对患者进行分层，未发现显著的生存差异。
RIS是长期存活癌症患者可能出现的并发症。因此，建议放疗后严格随访，以便早期诊断并对RIS患者进行最佳管理。在计划的随访期之后，考虑到发生RIS的长期风险，制定特定的多专科生存护理计划可能对患者有益。
