RESUMEN
BACKGROUND: Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer. METHODS: Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England. RESULTS: 22 patients were identified between 2010 and 2022. Median age of diagnosis was 65 years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5 years (range 2.4-16.0)-this interval has decreased over the last 24 years (r2 = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28 months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65 months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72 years had a median OS of 45 months vs 102 months for those ≤ 72 years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086). CONCLUSION: RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.
Asunto(s)
Neoplasias de la Mama , Hemangiosarcoma , Neoplasias Inducidas por Radiación , Neoplasias Primarias Secundarias , Humanos , Adulto , Persona de Mediana Edad , Anciano , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Hemangiosarcoma/etiología , Hemangiosarcoma/cirugía , Estudios Retrospectivos , Neoplasias Inducidas por Radiación/epidemiología , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/terapia , Recurrencia Local de Neoplasia/epidemiologíaRESUMEN
BACKGROUND: Angiosarcoma (AS) of the breast is very rare, accounting for 1% of all soft tissue breast tumors. AS may present as primary tumors of the breast or as secondary lesions usually associated with previous radiotherapy. Commonly, secondary AS affects older women (median age 67-71 years) with a clinical history of breast cancer. The preferred site of onset of RIAS is the edge of radiation fields, where radiation doses and tumor necrosis may be heterogeneous, resulting in a DNA damage and instability. Radical surgery is the treatment of choice, but no clear consensus exists on surgical management of breast AS. CASE REPORT: We describe an atypical case of relapsed RIAS after radical mastectomy, treated with new surgery and, considering the higher risk of recurrence, subsequent adjuvant chemotherapy with weekly paclitaxel. CONCLUSIONS: The frequency of radiation-induced angiosarcomas (RIAS) after breast-conserving surgery and radiotherapy has been increased to 0.14-0.5% among long survivors. Nevertheless, even if RIAS continues to be prognostically an extremely unfavorable cancer due to a high rate of recurrence, distant spread, and median overall survival (OS) of about 60 months, the benefits of loco-regional breast radiotherapy are clearly higher than the risk in developing angiosarcoma.
Asunto(s)
Neoplasias de la Mama , Hemangiosarcoma , Neoplasias Inducidas por Radiación , Femenino , Humanos , Anciano , Neoplasias de la Mama/patología , Hemangiosarcoma/etiología , Hemangiosarcoma/terapia , Hemangiosarcoma/patología , Mastectomía/efectos adversos , Terapia Combinada , Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias Inducidas por Radiación/terapia , Neoplasias Inducidas por Radiación/complicaciones , Radioterapia Adyuvante/efectos adversosRESUMEN
Radiation-induced breast sarcomas (RIBS) are rare entities representing <1% of all primary breast malignancies, limiting most reports to small retrospective case series. They constitute a heterogeneous group of neoplasms, with high-grade angiosarcoma being the most common subtype. Other sarcoma histotypes, such as undifferentiated pleomorphic sarcoma and leiomyosarcoma, can also be identified. Radiation-induced breast angiosarcoma (RIBA) has an incidence of approximately 0.1% after breast-conserving therapy and arises mainly from the dermis of the irradiated breast. MYC gene amplification is highly indicative of secondary breast angiosarcomas. Their clinical presentation often mimics benign port-radiation lesions, leading to a delay in diagnosis and a lost window of opportunity for cure. Surgery with negative margins is the mainstay of treatment of localized RIBS. In the case of angiosarcoma, technical difficulties, including multifocality, infiltrative margins, and difficulty in assessing tumor margins, render surgical treatment quite challenging. A limited number of studies showed that adjuvant radiation therapy reduces local recurrences; therefore, it is proposed by many groups for large, high-grade tumors. Chemotherapy has been evaluated retrospectively in a small subset of patients, with some evidence supporting its use in angiosarcoma patients. Approximately half of patients with RIBA will show local recurrence. In the advanced setting, different therapeutic options are discussed in the review, including chemotherapy, antiangiogenic therapy, and immunotherapy, whereas the need for further research on molecular therapeutic targets is pointed out.
Asunto(s)
Neoplasias de la Mama , Hemangiosarcoma , Neoplasias Inducidas por Radiación , Sarcoma , Neoplasias de los Tejidos Blandos , Neoplasias de la Mama/genética , Neoplasias de la Mama/radioterapia , Femenino , Hemangiosarcoma/genética , Hemangiosarcoma/terapia , Humanos , Márgenes de Escisión , Neoplasias Inducidas por Radiación/genética , Neoplasias Inducidas por Radiación/terapia , Estudios Retrospectivos , Sarcoma/genética , Sarcoma/terapiaRESUMEN
BACKGROUND: Primary leiomyosarcoma (LMS) of the gastrointestinal (GI) tract is rare. Limited literature exists regarding the clinical characteristics and outcome for patients with localised and metastatic disease. METHODS: A retrospective chart review was performed for patients greater than 18 years of age diagnosed with GI LMS at The Royal Marsden Hospital between 1 January 2000-1 May 2020. Descriptive statistics were performed. Patients were censored at data cut-off date of 27 June 2020. RESULTS: Forty-six patients with a median age at diagnosis of 54 years (range 25-85) were identified. Fifteen percent (n = 7) of patients previously received abdominal radiation for an unrelated cancer. All patients with localised disease (n = 36) had resection with oncological margins. For patients who underwent potentially curative surgery, median recurrence-free survival (mRFS) was 13 months (0.4-183 months), and half of these patients (n = 18) developed recurrent disease post resection (distant n = 16, local n = 2). Median overall survival (mOS) was 27 months for patients with distant recurrence. Twenty-one percent (n = 10) of patients presented with synchronous metastatic disease and their mOS was 19 months. Median progression-free survival (mPFS) for patients treated with conventional chemotherapy ranged from 2.0 to 8.0 months. CONCLUSION: The risk of recurrence is significant, and recurrence-free survival was short even with complete oncologic resection. The relationship of prior abdominal radiotherapy to the development of GI LMS warrants further investigation. Outcomes with systemic therapy for metastatic disease were poor and there is a need for the development of more effective systemic therapies.
Asunto(s)
Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/terapia , Leiomiosarcoma/secundario , Leiomiosarcoma/terapia , Recurrencia Local de Neoplasia/terapia , Neoplasias Inducidas por Radiación/fisiopatología , Neoplasias Inducidas por Radiación/terapia , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Márgenes de Escisión , Metastasectomía , Persona de Mediana Edad , Supervivencia sin Progresión , Radioterapia/efectos adversos , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To characterize the presentation, patterns of care, and outcomes of radiation-associated muscle-invasive bladder cancer (RA-MIBC) compared to primary (non-radiation associated) MIBC. RA-MIBC has been suggested to represent a more aggressive disease variant and be more difficult to treat compared to primary (non-radiation associated) MIBC. METHODS: We identified 60,090 patients diagnosed with MIBC between 1988-2015 using the Surveillance, Epidemiology, and End Results database and stratified patients based on whether radiation had been administered to a prior pelvic primary cancer. We used Fine-Gray competing risks regression to compare adjusted bladder cancer-specific mortality (BCSM) for RA-MIBC compared to primary MIBC. RESULTS: There were 1,093 patients with RA-MIBC and 58,997 patients with primary MIBC. RA-MIBCs were more likely to be T4 at diagnosis (21.0% vs 17.3%, P < .001), and less likely to be node-positive (10.3% vs 17.1%, P < .001). The rate of 5-year BCSM was significantly higher for patients with RA-MIBC vs primary MIBC (56.1% vs 35.3%, AHR 1.24, P < .001), even after stratification by other tumor, treatment and patient-specific factors. CONCLUSION: RA-MIBCs tended to present with higher grade and T stage disease and were less likely to receive curative treatment. Even when accounting for stage, grade, and receipt of treatment, patients with RA-MIBC had worse survival compared to those with primary MIBC. These findings suggest that RA-MIBC present unique clinical challenges and may also represent a biologically more aggressive disease compared to primary MIBC. Future research is needed to better understand the biology of RA-MIBC and develop improved treatment approaches.
Asunto(s)
Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias Inducidas por Radiación/terapia , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Invasividad Neoplásica , Estudios RetrospectivosRESUMEN
Ionising radiation-induced normal tissue damage is a major concern in clinic and public health. It is the most limiting factor in radiotherapy treatment of malignant diseases. It can also cause a serious harm to populations exposed to accidental radiation exposure or nuclear warfare. With regard to the clinical use of radiation, there has been a number of modalities used in the field of radiotherapy. These includes physical modalities such modified collimators or fractionation schedules in radiotherapy. In addition, there are a number of pharmacological agents such as essential fatty acids, vasoactive drugs, enzyme inhibitors, antioxidants, and growth factors for the prevention or treatment of radiation lesions in general. However, at present, there is no standard procedure for the treatment of radiation-induced normal tissue lesions. Stem cells and their role in tissue regeneration have been known to biologists, in particular to radiobiologists, for many years. It was only recently that the potential of stem cells was studied in the treatment of radiation lesions. Stem cells, immediately after their successful isolation from a variety of animal and human tissues, demonstrated their likely application in the treatment of various diseases. This paper describes the types and origin of stem cells, their characteristics, current research, and reviews their potential in the treatment and regeneration of radiation induced normal tissue lesions. Adult stem cells, among those mesenchymal stem cells (MSCs), are the most extensively studied of stem cells. This review focuses on the effects of MSCs in the treatment of radiation lesions.
Asunto(s)
Vesículas Extracelulares/metabolismo , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/metabolismo , Neoplasias Inducidas por Radiación/terapia , HumanosRESUMEN
BACKGROUND: Cancer survivors have a 14% increased risk of developing a malignancy compared with the general population. Second radiation-induced malignancies with different histologies have been described in different organs. Based on individual observations, we hypothesized that neuroendocrine carcinoma (NEC) could arise in irradiated organs. METHODS: In a retrospective analysis of Gustave Roussy database of NEC patients (small cell lung cancer excluded) diagnosed as a second cancer, we looked for the frequency of grade 3 NEC that arose in patients who had received previous radiation therapy for a first cancer. Radiation therapy for the first cancer, dose, location of radiation therapy, pathological characteristics, overall survival, and response to treatment of secondary NEC were analyzed. RESULTS: From January 1995 to December 2017, 847 cases of NEC were seen at Gustave Roussy. Among them, 95 (11.2%) patients had a history of previous malignancy of which 36 (4%) had been treated with radiation therapy. Out of these 36 patients, 12 (1.4% of all NEC patients) developed a NEC within the previous irradiated organ (median dose of 50 Gy, range 36-67.5). Most frequent first cancers were breast cancer (n = 4) and Hodgkin lymphoma (n = 3). NEC arose within a median time of 21.7 years (range 5.1-36.4) from radiation in the thorax (n = 5), digestive tract (n = 3), and other sites. Five large cell NEC, 3 small cell NEC, 1 mixed neuroendocrine neoplasm and 3 not otherwise specified NEC were diagnosed. Ten patients had stage IV disease at diagnosis; median overall survival was 37.8 months (95% CI [17.6 to NA]). Three patients (25%) achieved complete response with multimodal treatment. CONCLUSIONS: NEC can arise from previously irradiated organs and may have a better outcome in this setting. Other risk factors should be investigated to explain the high rate of previous cancer in this population of neuroendocrine neoplasm.
Asunto(s)
Carcinoma Neuroendocrino/etiología , Neoplasias Inducidas por Radiación , Neoplasias Primarias Secundarias/etiología , Adolescente , Adulto , Anciano , Carcinoma Neuroendocrino/terapia , Niño , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/radioterapia , Neoplasias Inducidas por Radiación/terapia , Neoplasias Primarias Secundarias/terapia , Radioterapia/efectos adversos , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
Mouse models of radiation-induced thymic lymphoma are commonly used to study the biological effects of total-body irradiation (TBI) on the formation of hematologic malignancies. It is well documented that radiation-induced thymic lymphoma can be inhibited by protecting the bone marrow (BM) from irradiation; however, the mechanisms underlying this phenomenon are poorly understood. Here, we aimed to address this question by performing transplantation of BM cells from genetically engineered mice that have defects in tumor immunosurveillance or occupying different thymic niches. We found that BM cells from mice that have impaired tumor immunosurveillance, by deleting tumor necrosis factor alpha (TNFα), interferon gamma (IFNγ) or perforin-1 (PRF1), remained sufficient to suppress the formation of radiation-induced thymic lymphoma. On the other hand, BM cells from Rag2-/-; γc-/- mice and Rag2-/- mice, which have defects in occupying thymic niches beyond double negative (DN2) and DN3, respectively, failed to inhibit radiation-induced lymphomagenesis in the thymus. Taken together, based on our findings, we propose a model where unirradiated BM cells suppress radiation-induced lymphomagenesis in the thymus by competing with tumor-initiating cells for thymic niches beyond the DN3 stage.
Asunto(s)
Trasplante de Médula Ósea , Linfoma/terapia , Neoplasias Inducidas por Radiación/terapia , Neoplasias del Timo/terapia , Animales , Células de la Médula Ósea/efectos de la radiación , Modelos Animales de Enfermedad , Humanos , Linfoma/etiología , Linfoma/prevención & control , Ratones , Ratones Endogámicos C57BL , Neoplasias Inducidas por Radiación/prevención & control , Neoplasias del Timo/etiología , Neoplasias del Timo/prevención & control , Irradiación Corporal Total/efectos adversosRESUMEN
Breast angiosarcoma is a rare vascular endothelial connective tissue tumor. It is primitive in young patients and radio-induced in older subjects. It is a malignant tumor and it manifests with polymorphic clinical and radiological features. Its prognosis is poor due to the frequent occurrence of visceral metastases and fast recurrence. We here report a case of breast angiosarcoma in a female patient aged 43 years, with a history of breast cancer, treated by conservative surgery and adjuvant radiotherapy. The purpose of this study is to highlight the epidemiological diagnostic and therapeutic features of these rare aggressive tumors.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Hemangiosarcoma/diagnóstico , Neoplasias Inducidas por Radiación/diagnóstico , Adulto , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Femenino , Hemangiosarcoma/patología , Hemangiosarcoma/terapia , Humanos , Neoplasias Inducidas por Radiación/patología , Neoplasias Inducidas por Radiación/terapia , Pronóstico , Radioterapia AdyuvanteAsunto(s)
Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias/radioterapia , Traumatismos Experimentales por Radiación/diagnóstico , Traumatismos por Radiación/diagnóstico , Radioterapia/métodos , Animales , Humanos , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/terapia , Guerra Nuclear/prevención & control , Efectos de la Radiación , Traumatismos por Radiación/prevención & control , Traumatismos por Radiación/terapia , Traumatismos Experimentales por Radiación/prevención & control , Radioterapia/efectos adversos , Investigadores/estadística & datos numéricos , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND AND AIMS: Compared to the general population, the incidence of thyroid cancer in childhood and adolescent and young adult malignancy survivors is increased 14.0-18.0 times (CI 11.7-23.8). The cumulative incidence is variably reported as 0.5% by age 45 with 30-year incidence of 1.3% in women and 0.6% in men. This study aims to evaluate the incidence of radiation-associated thyroid cancer amongst patients treated with prior radiation to the thyroid followed up in a late effects service. A secondary aim was to assess screening compliance in this cohort. METHODS: The medical records of all patients attending the late effects service from 1 January 2000 to 20 February 2013 were interrogated to identify patients exposed to thyroid irradiation. The screening compliance and incidence of thyroid cancer were assessed for the duration whilst under the guidance of the late effect service. Mode of diagnosis, all imaging and cytology were retrieved from the institutional electronic record. Cytology was categorized according to Bethesda. RESULTS: Four hundred and sixty-five patients were exposed to direct or scatter neck irradiation. Compliance with thyroid surveillance was observed in 76.9%. Ultrasound features of microcalcification and increased internal vascularity had a low sensitivity (62.5%) for predicting a malignant nodule, which improved when used in conjunction with a Bethesda IV-VI result (91.7%). However, cytological assessment was not performed in 45.6% of operative cases. Thirty-three patients had thyroid carcinoma of which 45.4% (n = 15) were incidental. The majority were papillary thyroid cancers (88.9%); of which 12.5% were node positive and 34.4% were multifocal. The incidence of thyroid cancer was elevated 57.6 times compared to the Australian general population (p < 0.001). CONCLUSION: Due to the high incidence of thyroid cancer, this study supports screening in this cohort. However, due to the risk of overtreatment, we endorse further investigation of thyroid nodules with ultrasound-guided fine-needle aspiration cytology based on sonographic criteria as for the general population and American Thyroid Association guidelines.
Asunto(s)
Neoplasias Inducidas por Radiación/epidemiología , Neoplasias de la Tiroides/epidemiología , Adolescente , Adulto , Australia , Biopsia con Aguja Fina , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Biopsia Guiada por Imagen , Lactante , Masculino , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/patología , Neoplasias Inducidas por Radiación/terapia , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Ultrasonografía Intervencional , Adulto JovenRESUMEN
PURPOSE: Meningiomas are common brain tumors, the majority of which are considered benign. Despite surgery and/or radiation therapy, recurrence rates are approximately 8-10%. One likely cause is the dysregulation of cyclin D-cyclin-dependent kinases 4 and 6 (CDK4/6)-retinoblastoma (Rb) pathway, which controls the cell cycle restriction point. This pathway is commonly dysregulated in anaplastic meningioma cell lines (AM) and radiation-induced meningioma cells (RIM), making it a rational target for anti-meningioma therapy. In this study, we investigate the effect of a CDK4/6 inhibitor, palbociclib, with radiation in relevant pre-clinical models. METHODS: In vitro cell culture, ex vivo slice culture and in vivo cell line-derived orthotopic xenograft animal models of AM/RIM were utilized to assess treatment efficacy with palbociclib plus radiation. Treatment effects were examined by immunoblot, cell viability, apoptosis, and cell cycle progression. RESULTS: The in vitro and ex vivo studies demonstrate that palbociclib plus radiation treatment reduced proliferation and has additional effects on cell cycling, including induction of an RB-associated G (1) arrest in Rb+ AM and RIM cells, but not in Rb- cells. Our results also demonstrated reduced CDK4 and CDK6 expression as well as reduced E2F target gene expression (CCNA2 and CCNE2) with the combination therapy. MRI results in vivo demonstrated reduced tumor size at 5 weeks when treated with 14 days palbociclib (10 mg/kg) plus 6 Gy radiation compared to saline-treated tumors. Finally, no hepatic toxicity was found after treatments. CONCLUSION: A pre-clinical murine model provides preclinical evidence for use of palbociclib plus radiation as a therapeutic agent for Rb+ meningiomas.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Meníngeas/terapia , Meningioma/terapia , Neoplasias Inducidas por Radiación/terapia , Piperazinas/uso terapéutico , Piridinas/uso terapéutico , Animales , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Terapia Combinada , Quinasa 4 Dependiente de la Ciclina/antagonistas & inhibidores , Quinasa 6 Dependiente de la Ciclina/antagonistas & inhibidores , Humanos , Masculino , Ratones , Proteína de Retinoblastoma/metabolismoRESUMEN
BACKGROUND: Despite improved survival, many pediatric brain tumor survivors receiving radiation therapy (RT) experience late effects. PROCEDURE: To study calvarial lesions in this population, we retrospectively reviewed records of patients undergoing neurosurgical evaluation for calvarial bone lesions detected in posttreatment follow-up imaging at St. Jude Children's Research Hospital. Primary tumor diagnosis, treatment, imaging, surgical intervention, and histopathology from patients with radiographic evidence of lesions followed for ≥2 years post-RT were studied. RESULTS: For 17 patients with 18 index lesions, median time to lesion manifestation was 2.34 years. Medulloblastoma patients developed lesions at a shorter interval from RT than ependymoma patients (P = .05). Twelve of 14 lesions requiring surgery were benign fibro-osseous or sclerotic. Two malignant lesions distinct from the primary tumor had genetic predisposition to malignancy. CONCLUSION: Most calvarial lesions arising post-RT are benign and fibro-osseous. Serial imaging is recommended, and high index of suspicion for malignant lesions is warranted for patients genetically predisposed to cancer.
Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias Cerebelosas/radioterapia , Ependimoma/radioterapia , Meduloblastoma/radioterapia , Neoplasias Inducidas por Radiación/patología , Radioterapia/efectos adversos , Neoplasias Craneales/patología , Adolescente , Neoplasias Cerebelosas/patología , Niño , Preescolar , Ependimoma/patología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Meduloblastoma/patología , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/terapia , Pronóstico , Estudios Retrospectivos , Neoplasias Craneales/etiología , Neoplasias Craneales/terapiaRESUMEN
The therapies used to treat Ewing sarcoma are associated with a risk of second malignant neoplasm (SMN). We conducted a systematic review to pool available evidence on the risks, types, and outcomes after SMN. We obtained 52 articles that met inclusion criteria. Cumulative incidence rates of SMN ranged from 0.9 to 8.4% and 10.1 to 20.5% at 5 and 30 years after initial diagnosis. Of the 327 reported SMNs, 63.6% were solid tumors, although acute myeloid leukemia /myelodysplastic syndrome was the single most commonly diagnosed SMN, with generally poor outcomes. Patients treated for Ewing sarcoma are at substantial risk of SMN, with a broad range of reported secondary cancers.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Óseas , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/etiología , Radioterapia/efectos adversos , Sarcoma de Ewing , Factores de Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/radioterapia , Neoplasias Óseas/cirugía , Carcinoma/epidemiología , Carcinoma/etiología , Carcinoma/terapia , Humanos , Incidencia , Leucemia Mieloide/epidemiología , Leucemia Mieloide/etiología , Leucemia Mieloide/terapia , Linfoma/epidemiología , Linfoma/etiología , Linfoma/terapia , Melanoma/epidemiología , Melanoma/etiología , Melanoma/terapia , Neoplasias Inducidas por Radiación/epidemiología , Neoplasias Inducidas por Radiación/terapia , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/terapia , Riesgo , Sarcoma/epidemiología , Sarcoma/etiología , Sarcoma/terapia , Sarcoma de Ewing/tratamiento farmacológico , Sarcoma de Ewing/radioterapia , Sarcoma de Ewing/cirugía , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Neoplasias de la Mama/terapia , Hemangiosarcoma/terapia , Neoplasias Inducidas por Radiación/terapia , Neoplasias Primarias Secundarias/terapia , Anciano , Implantes de Mama , Neoplasias de la Mama/etiología , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirugía , Femenino , Hemangiosarcoma/etiología , Humanos , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/etiología , Reirradiación , Colgajos Quirúrgicos/trasplanteAsunto(s)
Carcinoma de Pulmón de Células no Pequeñas/etiología , Enfermedad de Hodgkin/radioterapia , Neoplasias Pulmonares/etiología , Neoplasias Inducidas por Radiación/etiología , Sobrevivientes , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/terapia , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Neoplasias Inducidas por Radiación/mortalidad , Neoplasias Inducidas por Radiación/terapia , Seguridad del Paciente , Radioterapia/efectos adversos , Medición de Riesgo , Factores de RiesgoRESUMEN
Cutaneous epithelioid angiosarcoma is a rare neoplasm of vascular endothelial cell origin that can mimic a cutaneous lymphoma, metastatic carcinoma, or Kaposi sarcoma. It is one of the most malignant cutaneous tumors and early diagnosis is essential, as the tumor metastasizes quickly. We describe a 75-year-old man who presented with three tender, indurated violaceous plaques on his scalp. Biopsy revealed a poorly circumscribed infiltrate extending into the subcutaneous fat, composed of atypical epithelioid cells lining vascular spaces. We provide a brief review of the clinical presentation, histopathologic features, differential diagnosis, and management of this rare tumor.
Asunto(s)
Neoplasias de Cabeza y Cuello/patología , Hemangiosarcoma/patología , Neoplasias Inducidas por Radiación/patología , Neoplasias Cutáneas/patología , Anciano , Carcinoma/diagnóstico , Carcinoma/secundario , Procedimientos Quirúrgicos Dermatologicos/métodos , Diagnóstico Diferencial , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/terapia , Humanos , Linfoma Cutáneo de Células T/diagnóstico , Masculino , Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias Inducidas por Radiación/terapia , Radioterapia/efectos adversos , Radioterapia/métodos , Sarcoma de Kaposi/diagnóstico , Cuero Cabelludo , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Tiña del Cuero Cabelludo/radioterapiaAsunto(s)
Quimioradioterapia/métodos , Fraccionamiento de la Dosis de Radiación , Hemangiosarcoma/terapia , Neoplasias Inducidas por Radiación/terapia , Paclitaxel/uso terapéutico , Anciano de 80 o más Años , Mama/patología , Mama/efectos de la radiación , Neoplasias de la Mama/terapia , Diagnóstico Diferencial , Femenino , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/etiología , Humanos , Mastectomía Segmentaria , Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias Inducidas por Radiación/etiología , Radioterapia Adyuvante/efectos adversos , Sarcoma de Kaposi/diagnóstico , Piel/patología , Piel/efectos de la radiación , Resultado del TratamientoRESUMEN
INTRODUCTION: Osteosarcoma, a primary malignant bone tumor, has a well-recognised double peak of incidence in early adolescence and after 50 years. This study investigates the clinical features and prognostic factors of patients older than 50 years with osteosarcoma. MATERIEL AND METHODS: From January 2000 to December 2012, in one bone tumor reference center, 32 patients aged more than 50â¯yearsâ¯at the diagnosis (mean age: 62.4 years (50-85), sex ratio: 13 males, 19 females) diagnosed with osteosarcoma were included. Patients younger than 50â¯yearsâ¯at diagnosis or with a non-histologically proved osteosarcoma were excluded. For each patient, we registered medical history, tumor location, systemic and local extension, treatment, and survival. RESULTS: 62% were located in the extremities and 28% in the axial skeleton. 6 were secondary sarcomas. Mean delay between first symptoms and biopsy was 7.4 months (range from 0 to 28 months). Ten patients had a systemic osteosarcoma with one or more pulmonary metastases. Six patients were treated with palliative care (18.8%). Eighteen patients received neodajuvant chemotherapy, sixteen of them received postoperative chemotherapy. Twenty-five patients had surgery. Postoperative complications were reported in eight cases (25%). Overall survival for all 31 patients was 25% at 5 years and 6.2% at 10 years. Survival without metastases was 15.6% at 5 years and nil at 10 years. Median survival time for the 22 localised osteosarcoma patients was 4 years (0.9-12.6) versus 1.2 years (0.3-12.3) for the 10 systemic osteosarcoma patients (pâ¯=â¯0.01). CONCLUSION: Metastases at diagnosis, age, axial location are worse prognostic for survival.
Asunto(s)
Neoplasias Óseas/terapia , Quimioterapia Adyuvante , Terapia Neoadyuvante , Procedimientos Ortopédicos , Osteosarcoma/terapia , Complicaciones Posoperatorias/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/patología , Extremidades , Femenino , Neoplasias Femorales/patología , Neoplasias Femorales/terapia , Humanos , Húmero/patología , Húmero/cirugía , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/patología , Neoplasias Inducidas por Radiación/terapia , Neoplasias Primarias Secundarias/patología , Neoplasias Primarias Secundarias/terapia , Osteosarcoma/patología , Osteosarcoma/secundario , Cuidados Paliativos , Huesos Pélvicos/patología , Pronóstico , Estudios Retrospectivos , Escápula/patología , Escápula/cirugía , Tasa de Supervivencia , Tibia/patología , Tibia/cirugía , Factores de TiempoRESUMEN
Childhood cancer survivors are at risk for ongoing health risks related to their initial treatment. One potential long-term complication following radiation is the development of secondary tumors, including peripheral nerve tumors, such as schwannomas. We present three adolescent and young adult (AYA)-aged survivors of pediatric cancer (22-40 years), followed in our AYA survivorship clinic. Each was found to have a schwannoma many years following total body irradiation for a childhood primary malignancy. We highlight a late effect of low-dose total body irradiation as well as the importance of long-term monitoring in this population.