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Post-Radiation Sarcoma- Living in Fear
“Complications that arise from Post-Radiation Sarcoma are those seen with other soft-tissue and bone tumors, such as pathologic fractures, hemorrhage, metastases, and local complications due to direct invasion.”
The odds of my developing a post-radiation sarcoma (PRS) from my radiation treatment all those years ago is low. Five percent or less. So why do I worry? According to the two articles linked and excerpted below I think I live in fear because PRS sounds like a nightmare side effect. And as long as I’m alive, I can develop one.
- Although the implication for individual patients is significant, little doubt exists that the benefits of ionizing radiation therapy far outweigh the potential risks of developing sarcomas- I’m not sure I had to have the radiation…
- Development of PRS also is influenced by other factors, including genetic tendency and influence of chemotherapeutic agents-I had lots of chemotherapy before and after my radiation therapy…
- The overall reported 5-year survival rates for patients with PRS have been poor, ranging from 8.7% to 22% in different studies– Conventional oncology can’t do much for PRS…
- Careful staging is a prerequisite for appropriate management of PRS- Why? Oncology can’t help much beside providing palliative chemotherapy.
- Lowering the dosage of radiation and/or adjuvant chemotherapy is the only preventive measure for PRS-
I live in fear of a treatment-related secondary cancer both from my chemotherapy and my radiation. After all the chemo and radiation I had the odds are high and growing anually. I was recently diagnosed with chemotherapy-induced cardiomyopathy. I’m confident that my oncologists knew of all of the risks but went ahead thinking that my cancer, multiple myeloma, was incurable anyway. So how am I writing this blog post 25 years after the fact?
Why do oncologists prescribe therapies that often don’t work but can cause very real harm to the patient?!?
Have you got a treatment-related horror story that you would like to share? Scroll down the page, post a question or comment and I will reply to you ASAP.
Thank you,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Radiation-associated sarcoma of bone and soft tissue.
Arch Surg. 1992 Dec;127(12):1379-85.
“Radiation-associated sarcomas are uncommon, constituting less than 5% of all sarcomas, and generally associated with a poor prognosis. We reviewed the medical records of 565 patients with sarcoma and a second malignancy seen at our institution between 1943 and 1989; 160 of these patients (28%) were considered to have a radiation-associated sarcoma. The most common diagnosis for which radiation had been given was breast cancer (26%), followed by lymphoma (25%) and carcinoma of the cervix (14%). The most common histologic types of radiation-associated sarcoma were osteogenic (21%), malignant fibrous histiocytoma (16%), and angiosarcoma/lymphangiosarcoma (15%). Most of the tumors were high grade (87%). Three variables had prognostic significance in multivariate analysis: the presence of metastatic disease, the completeness of operative resection in patients with localized disease, and the size of the primary tumor in patients who underwent complete resection of the sarcoma. Survival was independent of histologic subtype or site of disease.”
Postradiation Sarcoma
“A late effect of ionizing radiation is the development of sarcoma within the field of irradiation, referred to as post-radiation sarcoma (PRS)…
Although the implication for individual patients is significant, little doubt exists that the benefits of ionizing radiation therapy far outweigh the potential risks of developing sarcomas...
The threshold dose for PRS is not known, though in most published series, a dose of 40-60 Gy has been reported. [2, 11, 12] Development of PRS also is influenced by other factors, including genetic tendency and influence of chemotherapeutic agents...
Patients of all ages are affected. In the Mayo study (N = 130), the average age at diagnosis of index lesion was 28.7 years (range, 4 months to 65 years). [10] The mean age at diagnosis of PRS was 47.9 years (range, 10.5-80.9). The latent period ranged from 4 years to 55 years (average, 17)…
The overall reported 5-year survival rates for patients with PRS have been poor, ranging from 8.7% to 22% in different studies. [11, 12, 17, 18, 19, 20]…
Pain is the most common complaint in patients with postradiation sarcoma (PRS). 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..
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...
Differential diagnoses for bone pain in a patient with a history of irradiation include the following:
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Metastatic bone disease
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Radiation osteopathy
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Nonneoplastic causes of bone pain, such as rotator cuff impingement syndrome, osteoarthritis, bursitis/tendonitis, gout, and pseudogout…
No specific laboratory blood tests are used to diagnose postradiation sarcoma (PRS). Routine laboratory investigations may be ordered.
Cytogenetic studies on PRS tumor cells do not have much value, because the tumor cells can have numerous quantitative (numerical) and qualitative abnormalities that lack specificity. However, the value of cytogenetic analysis lies in excluding other conditions that may have specific anomalies and that may present a challenge in light-microscopic examination…
Plain radiographs should be obtained in two planes. Cortical bone destruction is the most common finding. A mineralized soft-tissue mass is seen in most patients. Changes such as osteopenia and sclerosis are seen in a minority of patients.
If plain radiography yields normal findings and the patient has significant pain, computed tomography (CT) and magnetic resonance imaging (MRI) are useful for identifying abnormal areas in the medullary cavity, cortical bone destruction, and the presence of an extramedullary soft-tissue mass. MRI is the best modality for detecting soft-tissue involvement in PRS. Chest CT is performed to detect pulmonary metastases…
Fine-needle aspiration (FNA) biopsies or Tru-Cut core biopsies can be obtained from the lesion for histopathologic/cytopathologic confirmation of diagnosis and for typing and grading of the lesion. In the case of a deep-seated lesion, CT-guided biopsies can be obtained…
PRS in bone and soft tissue usually is a high-grade lesion, and this partly accounts for the almost uniformly grim prognosis. [4, 7]…
Careful staging is a prerequisite for appropriate management of PRS. The marrow extent and soft-tissue involvement of PRS should be gauged by using radiologic modalities, of which MRI is the best choice. Biopsies may be obtained to confirm the diagnosis and to type and grade the lesion…
Because PRS is high grade and advanced stage or metastatic at the time of diagnosis, patients commonly are not eligible for curative surgery, and their prognosis generally is poor. Chemotherapy is the most common treatment modality and typically is associated with poor response rates…
Prevention
Lowering the dosage of radiation and/or adjuvant chemotherapy is the only preventive measure for PRS; however, such reductions may not be practicable. The discontinuance of radiation for benign bone and soft-tissue diseases has limited PRS to patients receiving radiation treatment for malignancies…”