Skip to main content

Advertisement

SpringerLink
Log in

Radiation-induced sarcoma of head and neck: 50 years of experience at a single institution in an endemic area of nasopharyngeal carcinoma in China

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Radiation-induced sarcoma in the head and neck (RISHN) is a rare condition whose clinical presentation and management remain difficult because of its low incidence. In this retrospective study, we analyzed the symptoms, diagnosis, and the treatment of 16,634 patients with head and neck disease, who received radiotherapy between 1960 and 2010 at the Affiliated Tumor Hospital and its predecessor, Guangxi Medical University, China. Among these patients, 16 with a first tumor of nasopharyngeal carcinoma (NPC) and 1 with squamous carcinoma of the tongue met the criteria of RISHN in the head and neck. Our epidemiological data showed that the incidence of RISHN rose from 0.06 to 0.17% from 1960 to 2010; the 3-year overall survival rate was 19.1%, and 3-year disease-free survival rate was 11.1%. The mean latency (SD) period was 93.2 (33) months. Based on the experiences at our institution, we suggest that RISHN is a rare complication after radiotherapy for head and neck tumors, especially NPC. Owing to its low incidence, it should not be a major factor affecting decisions about radiotherapy. Nevertheless, there may be a possibility of increasing incidence of RISHN after radiotherapy of NPC, as shown in our epidemiological results. Given the poor prognosis of RISHN, this possibility should be taken into serious consideration before determination of high-dose radiotherapy for patients with NPC and other head and neck tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ravichandran R. Has the time come for doing away with cobalt-60 teletherapy for cancer treatments. J Med Phys. 2009;34(2):63–5.

    Article  PubMed  CAS  Google Scholar 

  2. Holt GE, Thomson AB, Griffin AM, et al. Multifocality and multifocal postradiation sarcomas. Clin Orthop Relat Res. 2006;450:67–75.

    Article  PubMed  Google Scholar 

  3. Mark RJ, Bailet JW, Poen J, et al. Postirradiation sarcoma of the head and neck. Cancer. 1993;72(3):887–93.

    Article  PubMed  CAS  Google Scholar 

  4. Maghami EG, St-John M, Bhuta S, Abemayor E. Postirradiation sarcoma: a case report and current review. Am J Otolaryngol. 2005;26(1):71–4.

    Article  PubMed  Google Scholar 

  5. Devi BC, Pisani P, Tang TS, Parkin DM. High incidence of nasopharyngeal carcinoma in native people of Sarawak, Borneo Island. Cancer Epidemiol Biomarkers Prev. 2004;13(3):482–6.

    PubMed  Google Scholar 

  6. Cancer incidence in five continents: vol V, vol 88. IARC Science Publication; 1987. p. 1–970.

  7. Li JY, Liu BQ, Li GY, Chen ZJ, Sun XI, Rong SD. Atlas of cancer mortality in the People’s Republic of China. An aid for cancer control and research. Int J Epidemiol. 1981;10(2):127–33.

    Article  PubMed  CAS  Google Scholar 

  8. Yu MC, Mo CC, Chong WX, Yeh FS, Henderson BE. Preserved foods and nasopharyngeal carcinoma: a case–control study in Guangxi, China. Cancer Res. 1988;48(7):1954–9.

    PubMed  CAS  Google Scholar 

  9. Lin JC, Jan JS. Locally advanced nasopharyngeal cancer: long-term outcomes of radiation therapy. Radiology. 1999;211(2):513–8.

    PubMed  CAS  Google Scholar 

  10. Patel SG, See AC, Williamson PA, Archer DJ, Evans PH. Radiation induced sarcoma of the head and neck. Head Neck. 1999;21(4):346–54.

    Article  PubMed  CAS  Google Scholar 

  11. Mark RJ, Poen J, Tran LM, Fu YS, Selch MT, Parker RG. Postirradiation sarcomas. A single-institution study and review of the literature. Cancer. 1994;73(10):2653–62.

    Article  PubMed  CAS  Google Scholar 

  12. Cahan WG, Woodard HQ, et al. Sarcoma arising in irradiated bone: report of 11 cases. Cancer. 1948;1(1):3–29.

    Article  PubMed  CAS  Google Scholar 

  13. Murray EM, Werner D, Greeff EA, Taylor DA. Postradiation sarcomas: 20 cases and a literature review. Int J Radiat Oncol Biol Phys. 1999;45(4):951–61.

    Article  PubMed  CAS  Google Scholar 

  14. King AD, Ahuja AT, Teo P, Tse GM, Kew J. Radiation induced sarcomas of the head and neck following radiotherapy for nasopharyngeal carcinoma. Clin Radiol. 2000;55(9):684–9.

    Article  PubMed  CAS  Google Scholar 

  15. Baujat B, Audry H, Bourhis J, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys. 2006;64(1):47–56.

    Article  PubMed  CAS  Google Scholar 

  16. Faulkner K, Moores BM. Radiation dose and somatic risk from computed tomography. Acta Radiol. 1987;28(4):483–8.

    Article  PubMed  CAS  Google Scholar 

  17. Huda W. Is energy imparted a good measure of the radiation risk associated with CT examinations? Phys Med Biol. 1984;29(9):1137–42.

    Article  PubMed  CAS  Google Scholar 

  18. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–96.

    PubMed  CAS  Google Scholar 

  19. Strong LC, Herson J, Osborne BM, Sutow WW. Risk of radiation-related subsequent malignant tumors in survivors of Ewing’s sarcoma. J Natl Cancer Inst. 1979;62(6):1401–6.

    PubMed  CAS  Google Scholar 

  20. Boivin JF, O’Brien K. Solid cancer risk after treatment of Hodgkin’s disease. Cancer. 1988;61(12):2541–6.

    Article  PubMed  CAS  Google Scholar 

  21. Fox C, Romeijn HE, Lynch B, Men C, Aleman DM, Dempsey JF. Comparative analysis of 60Co intensity-modulated radiation therapy. Phys Med Biol. 2008;53(12):3175–88.

    Article  PubMed  CAS  Google Scholar 

  22. Buchanan R. Cobalt on the way out. Br Med J (Clin Res Ed). 1986;292(6516):290.

    Article  CAS  Google Scholar 

  23. Wiklund TA, Blomqvist CP, Raty J, Elomaa I, Rissanen P, Miettinen M. Postirradiation sarcoma. Analysis of a nationwide cancer registry material. Cancer. 1991;68(3):524–31.

    Article  PubMed  CAS  Google Scholar 

  24. Seo IS, Warner TF, Warren JS, Bennett JE. Cutaneous postirradiation sarcoma. Ultrastructural evidence of pluripotential mesenchymal cell derivation. Cancer. 1985;56(4):761–7.

    Article  PubMed  CAS  Google Scholar 

  25. Amendola BE, Amendola MA, McClatchey KD, Miller CH Jr. Radiation-associated sarcoma: a review of 23 patients with postradiation sarcoma over a 50-year period. Am J Clin Oncol. 1989;12(5):411–5.

    Article  PubMed  CAS  Google Scholar 

  26. Laskin WB, Silverman TA, Enzinger FM. Postradiation soft tissue sarcomas. An analysis of 53 cases. Cancer. 1988;62(11):2330–40.

    Article  PubMed  CAS  Google Scholar 

  27. Sale KA, Wallace DI, Girod DA, Tsue TT. Radiation-induced malignancy of the head and neck. Otolaryngol Head Neck Surg. 2004;131(5):643–5.

    Article  PubMed  Google Scholar 

  28. Miyahara H, Sato T, Yoshino K. Radiation-induced cancers of the head and neck region. Acta Otolaryngol Suppl. 1998;533:60–4.

    PubMed  CAS  Google Scholar 

  29. van der Laan BF, Baris G, Gregor RT, Hilgers FJ, Balm AJ. Radiation-induced tumours of the head and neck. J Laryngol Otol. 1995;109(4):346–9.

    PubMed  Google Scholar 

  30. Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev. 2006;15(10):1765–77.

    Article  PubMed  CAS  Google Scholar 

  31. Lee AW, Foo W, Mang O, et al. Changing epidemiology of nasopharyngeal carcinoma in Hong Kong over a 20-year period (1980–1999): an encouraging reduction in both incidence and mortality. Int J Cancer. 2003;103(5):680–5.

    Article  PubMed  CAS  Google Scholar 

  32. Ko JY, Chen CL, Lui LT, Hsu MM. Radiation-induced malignant fibrous histiocytoma in patients with nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 1996;122(5):535–8.

    Article  PubMed  CAS  Google Scholar 

  33. Afqir S, Ismaili N, Alaoui K, et al. Nasopharyngeal carcinoma in adolescents: a retrospective review of 42 patients. Eur Arch Otorhinolaryngol. 2009;266(11):1767–73.

    Article  PubMed  Google Scholar 

  34. Ou SH, Zell JA, Ziogas A, Anton-Culver H. Epidemiology of nasopharyngeal carcinoma in the United States: improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology. Ann Oncol. 2007;18(1):29–35.

    Article  PubMed  Google Scholar 

  35. Weatherby RP, Dahlin DC, Ivins JC. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases. Mayo Clin Proc. 1981;56(5):294–306.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by the Guangxi Natural Science Foundation of China for Youth (No. 2010GXNSFB013067), the Special Foundation of the Key Laboratory of Early Prevention and Treatment for Regional High Incidence Tumor(0842009-Z12)and Guangxi Medical University Research Foundation for PhD (304193). The authors express their gratitude to the staff of the radiotherapy department of the Affiliated Tumor Hospital of Guangxi Medical University for excellent technical help and constructive criticism. We also thank Dr. Armando Chapin Rodriguez for his editing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China

    Zhengbo Wei & Jian Xu

  2. Key Laboratory of Early Prevention and Treatment for Regional High Incidence Tumor, Experimental Center of Medical Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China

    Ying Xie

  3. Department of Pathology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China

    Yuan Luo & Falong Chen

  4. Department of Radiotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China

    Yunli Yang & Qifang Huang

  5. Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China

    Anzhou Tang & Guangwu Huang

Authors
  1. Zhengbo Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jian Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuan Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Falong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yunli Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qifang Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anzhou Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Guangwu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ying Xie.

Additional information

Y. Xie contributed equally.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wei, Z., Xie, Y., Xu, J. et al. Radiation-induced sarcoma of head and neck: 50 years of experience at a single institution in an endemic area of nasopharyngeal carcinoma in China. Med Oncol 29, 670–676 (2012). https://doi.org/10.1007/s12032-011-9828-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12032-011-9828-9

Keywords

Search

Navigation