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Post-irradiation sarcoma after definitive radiation therapy for nasopharyngeal carcinoma

  • Wan-Yu Chen
    Affiliations
    Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan

    National Taiwan University Cancer Center, Taipei, Taiwan
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  • Szu-Huai Lu
    Affiliations
    Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan
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  • Yu-Ming Wang
    Affiliations
    Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chun-Wei Wang
    Affiliations
    Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan

    Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan

    Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Ku-Hao Fang
    Affiliations
    Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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  • Shih-Fan Lai
    Affiliations
    Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan

    National Taiwan University Cancer Center, Taipei, Taiwan
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  • Hsiang-Kuang Liang
    Affiliations
    Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan

    National Taiwan University Cancer Center, Taipei, Taiwan
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  • Bing-Shen Huang
    Correspondence
    Corresponding author at: Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan.
    Affiliations
    Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Published:November 23, 2022DOI:https://doi.org/10.1016/j.radonc.2022.11.012

      Highlights

      • Postirradiation sarcoma (PIS) is a rare radiation-induced malignancy after nasopharyngeal carcinoma (NPC) treatment.
      • DVH analysis demonstrated that PIS occurred mainly within high dose (>55Gy) region.
      • Higher radiation energy and modern technology were associated with shortened PIS latency time.
      • After PIS development, surgery, compared with radiation or systemic therapy, was associated with better survival.

      Abstract

      Background and purpose

      Postirradiation sarcoma (PIS) is a rare radiation-induced malignancy after nasopharyngeal carcinoma (NPC) treatment.

      Materials and methods

      We retrospectively screened 9,185 NPC patients between 2000 and 2020 and identified 41 patients with PIS according to the modified Cahan’s criteria: (1) the PIS must have arisen within a previous radiation field; (2) a latent period must have existed; (3) histologically proved sarcoma; (4) the tissue in which the PIS arose must have been healthy prior to the radiation. The initial radiation therapy techniques used were 2D (25; 61.0%), 3D (7; 17.1%), and IMRT (9; 22%).

      Results

      The time (year) from radiotherapy (RT) to PIS was longer when using 2D or 3D irradiation techniques (median, 14.2; range, 3.4–28.1; Q1-Q3, 8.6–19.7) than when using IMRT (median, 6.6; range, 3.8–15.7; Q1-Q3, 4.5–11.7; P =.026). The time (year) from RT to PIS diagnosis was significantly longer when using lower radiation energy from cobalt-60 (median, 15.8; range, 10.4–28.4; Q1-Q3, 12.5–23.8) than when using a higher radiation energy of 6 or 10 MV (median, 10.2; range, 3.4–23.3; Q1-Q3, 6.5–16.1; P =.006). The 2-year overall survival rates for patients who underwent surgery, radical radiotherapy, systemic therapy alone and no treatment were 60.7 %, 42.9 %, 0 % and 0 %, respectively (P =.000). Of the 3 retrievable initial RT dosimetry plans for NPC, the D95 values (dose that covers 95 % of the PIS volume) for PIS were 6267, 6344 and 5820 cGy, respectively.

      Conclusion

      High radiation energy and modern techniques may shorten NPC PIS latency. Surgery may be associated with improved survival if feasible.

      Keywords

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