Postradiation Sarcoma Medication

  • Author: Nagarjun Rao, MD, FRCPath; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 6, 2012
 
 

Medication Summary

The selection of chemotherapy agents used to treat patients with postradiation sarcoma (PRS) is based largely upon data from clinical trials of soft-tissue and bone sarcomas. The 2 most active single chemotherapy agents are doxorubicin (Adriamycin) and ifosfamide. These agents have roughly equivalent activity. Dacarbazine (DTIC) has modest single-agent activity. MAID (combination of mesna, Adriamycin, ifosfamide, and DTIC) has been a commonly used combination chemotherapy regimen for the treatment of soft-tissue sarcoma over the past decade.

Three randomized trials have been performed in which regimens containing Adriamycin and ifosfamide were compared with Adriamycin alone. Two of these trials showed higher response rates in the treatment arms containing Adriamycin and ifosfamide than in those containing Adriamycin alone. However, the Adriamycin and ifosfamide combinations also were associated with significantly higher myelosuppression (including fatal neutropenic sepsis) but no survival advantage. No standard of care has been established for the choice of chemotherapy agents. Therefore, treatment typically is individualized.

Preoperative chemotherapy can be administered with or without radiation therapy and is administered either intravenously (as a bolus or as a continuous infusion) or regionally via an intra-arterial infusion to an isolated limb. Preoperative chemotherapy generally is considered in order to facilitate a limb-sparing procedure. This approach is considered for patients who otherwise would require amputation for cure or palliation. In some instances, this approach may be considered to convert a marginally resectable lesion into one that is operable. Consideration of preoperative chemotherapy for PRS must take into account that response rates to chemotherapy are low and that most long-term survivors with PRS are patients who have undergone successful surgical resection.

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Contributor Information and Disclosures
Author

Nagarjun Rao, MD, FRCPath  Associate Professor, Department of Pathology, Medical College of Wisconsin

Nagarjun Rao, MD, FRCPath is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, Royal College of Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Donald A Hackbarth Jr, MD, FACS  Professor of Clinical Orthopedic Surgery, Division Chief, Musculoskeletal Oncology, Department of Orthopedic Surgery, Medical College of Wisconsin

Donald A Hackbarth Jr, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Tissue Banks, American College of Surgeons, Children's Oncology Group, Christian Medical & Dental Society, Clinical Orthopaedic Society, and Wisconsin Medical Society

Disclosure: Musculoskeletal Transplant Foundation Honoraria Board membership

Stuart Wong, MD  Assistant Professor, Department of Medicine, Section of Hematology/Oncology, Froedert Memorial Lutheran Hospital

Disclosure: Nothing to disclose.

Vivek Panikkar, MBBS, MS, MCh, FRCS  Consulting Surgeon, Departments of Trauma and Orthopedics, Doncaster Royal Infirmary, UK

Disclosure: Nothing to disclose.

Vinod B Shidham, MD, FRCPath  Professor, Vice-chair-AP, and Director of Cytopathology, Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center & Detroit Medical Center; Co-Editor-in-Chief and Executive Editor, CytoJournal

Vinod B Shidham, MD, FRCPath is a member of the following medical societies: American Association for Cancer Research, American Society of Cytopathology, College of American Pathologists, International Academy of Cytology, Royal College of Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Sean P Scully, MD, PhD  Professor, Department of Orthopedics, University of Miami

Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Cahan WG. Radiation-induced sarcoma--50 years later. Cancer. Jan 1 1998;82(1):6-7. [Medline].

  2. Smith LM, Cox RS, Donaldson SS. Second cancers in long-term survivors of Ewing's sarcoma. Clin Orthop. Jan 1992;(274):275-81. [Medline].

  3. Cahan WG, Woodard HQ, Higinbotham NL, et al. Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer. Jan 1 1998;82(1):8-34. [Medline].

  4. Debeer P, Van de Meulebroucke B, Stuyck J, Sciot R, Samson I. Postradiation soft tissue sarcoma of the shoulder: a case report. Acta Orthop Belg. Aug 2007;73(4):521-4. [Medline].

  5. Nicolas MM, Nayar R, Yeldandi A, De Frias DV. Pulmonary metastasis of a postradiation breast epithelioid angiosarcoma mimicking adenocarcinoma. A case report. Acta Cytol. Nov-Dec 2006;50(6):672-6. [Medline].

  6. Hanasono MM, Osborne MP, Dielubanza EJ, Peters SB, Gayle LB. Radiation-induced angiosarcoma after mastectomy and TRAM flap breast reconstruction. Ann Plast Surg. Feb 2005;54(2):211-4. [Medline].

  7. Fang Z, Matsumoto S, Ae K, Kawaguchi N, Yoshikawa H, Ueda T. Postradiation soft tissue sarcoma: a multiinstitutional analysis of 14 cases in Japan. J Orthop Sci. 2004;9(3):242-6. [Medline].

  8. Fangman WL, Cook JL. Postradiation sarcoma: case report and review of the potential complications of therapeutic ionizing radiation. Dermatol Surg. Aug 2005;31(8 Pt 1):966-72. [Medline].

  9. Mullah-Ali A, Ramsay JA, Bourgeois JM, Hodson I, Macdonald P, Midia M, et al. Paraspinal synovial sarcoma as an unusual postradiation complication in pediatric abdominal neuroblastoma. J Pediatr Hematol Oncol. Jul 2008;30(7):553-7. [Medline].

  10. Inoue YZ, Frassica FJ, Sim FH, et al. Clinicopathologic features and treatment of postirradiation sarcoma of bone and soft tissue. J Surg Oncol. Sep 2000;75(1):42-50. [Medline].

  11. Neuhaus SJ, Pinnock N, Giblin V, Fisher C, Thway K, Thomas JM, et al. Treatment and outcome of radiation-induced soft-tissue sarcomas at a specialist institution. Eur J Surg Oncol. Dec 27 2008;[Medline].

  12. Bjerkehagen B, Smeland S, Walberg L, Skjeldal S, Hall KS, Nesland JM, et al. Radiation-induced sarcoma: 25-year experience from the Norwegian Radium Hospital. Acta Oncol. 2008;47(8):1475-82. [Medline].

  13. Amendola BE, Amendola MA, McClatchey KD, et al. Radiation-associated sarcoma: a review of 23 patients with postradiation sarcoma over a 50-year period. Am J Clin Oncol. Oct 1989;12(5):411-5. [Medline].

  14. Taghian A, de Vathaire F, Terrier P, et al. Long-term risk of sarcoma following radiation treatment for breast cancer. Int J Radiat Oncol Biol Phys. Jul 1991;21(2):361-7. [Medline].

  15. Strauss PG, Schmidt J, Pedersen L, et al. Amplification of endogenous proviral MuLV sequences in radiation- induced osteosarcomas. Int J Cancer. Apr 15 1988;41(4):616-21. [Medline].

  16. Pitcher ME, Davidson TI, Fisher C, et al. Post irradiation sarcoma of soft tissue and bone. Eur J Surg Oncol. Feb 1994;20(1):53-6. [Medline].

  17. Smith J. Radiation-induced sarcoma of bone: clinical and radiographic findings in 43 patients irradiated for soft tissue neoplasms. Clin Radiol. Mar 1982;33(2):205-21. [Medline].

  18. Papalas JA, Wylie JD, Vollmer RT. Osteosarcoma after radiotherapy for prostate cancer. Ann Diagn Pathol. Jun 2011;15(3):194-7. [Medline].

  19. Weaver J, Billings SD. Postradiation cutaneous vascular tumors of the breast: a review. Semin Diagn Pathol. Aug 2009;26(3):141-9. [Medline].

  20. Enzinger FM, Weiss SW. General considerations. In: Soft Tissue Tumors. 3rd ed. St. Louis:. Mosby;1995.

  21. Brown J, Byers T, Thompson K, et al. A cancer journal for clinicians: nutrition during and after cancer treatment. In: A Guide for Informed Choices by Cancer Survivors. Vol 51. 2001.

  22. Kalra S, Grimer RJ, Spooner D, Carter SR, Tillman RM, Abudu A. Radiation-induced sarcomas of bone: factors that affect outcome. J Bone Joint Surg Br. Jun 2007;89(6):808-13. [Medline].

 
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Light microscopic appearance of postradiation osteosarcoma; tumor is composed of pleomorphic plump spindle cells with focal presence of neoplastic osteoid (pink areas) in between tumor cells. This meningeal tumor occurred 10 years postradiation in a patient who had received radiation for a recurrent pituitary neoplasm.
 
 
 
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