History and Physical Examination
Pain is the most common complaint in patients with postradiation sarcoma (PRS; also referred to as radiation-induced sarcoma [RIS]). This pain is abrupt and rapid in onset, relentless and progressive, constant, and worse at night. It usually is not relieved by aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Mass (soft tissue or bone), bleeding, and pathologic fracture also are reported. [22, 23] Clinical factors that favor a diagnosis of PRS include the following:
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Sarcoma in bone or soft tissue appearing at an unusual age
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Sarcoma in bone or soft tissue at an unusual site
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Addition of intensive chemotherapy to irradiation
Physical findings are localized to the irradiated area. These usually are a mass (bony or soft tissue), tenderness, and/or a pathologic fracture.
Complications
PRS is itself a complication of radiation treatment for various bone and soft-tissue malignancies. Complications that arise from PRS are those seen with other soft-tissue and bone tumors, such as pathologic fractures, hemorrhage, metastases, and local complications due to direct invasion.
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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 after radiation therapy in patient who had received such therapy for recurrent pituitary neoplasm.
