Ognerubov NA, Antipova TS. Radiation-induced soft tissue sarcoma of the neck after radiation therapy for Hodgkin's lymphoma: a clinical case. Journal of Modern Oncology. 2022;24(3):325–330.
DOI: 10.26442/18151434.2022.3.201904
Ognerubov NA, Antipova TS. Radiation-induced soft tissue sarcoma of the neck after radiation therapy for Hodgkin's lymphoma: a clinical case. Journal of Modern Oncology. 2022;24(3):325–330.
DOI: 10.26442/18151434.2022.3.201904
Обоснование. Радиационно-индуцированные злокачественные новообразования возникают как долгосрочные осложнения лучевой терапии, широко применяемой для лечения ряда опухолей. Латентный период до развития второй опухоли колеблется от 3 до 60 лет. Эпителиальные опухоли и гемобластозы возникают после лучевой терапии в низких дозах, а саркомы – в высоких дозах. Цель. Представить случай радиационно-индуцированной ангиосаркомы мягких тканей шеи после излечения болезни Ходжкина. Материалы и методы. Под наблюдением находилась больная 41 года, которой в 2004 г. по поводу лимфомы Ходжкина с лимфоидным преобладанием стадии IIIA с поражением шейно-надключичных лимфоузлов справа, средостения и лимфоузлов брюшной полости проведено 4 цикла полихимиотерапии по схеме ABVD с последующей лучевой терапией шейно-надключичных лимфоузлов справа и средостения, суммарная очаговая доза – 40 Гр. Результаты. Через 17 лет после окончания лечения болезни Ходжкина, включая лучевую терапию, у больной появились болезненная отечность мягких тканей шеи в зоне облучения с переходом на переднюю стенку грудной клетки и увеличенный шейный лимфоузел. Выполнена лимфодиссекция. По данным комбинированной позитронно-эмиссионной и рентгеновской компьютерной томографии (ПЭТ/КТ), гистологического и иммуногистохимического исследований установлена эпителиоидная ангиосаркома мягких тканей шеи и грудной стенки стадии IV cT2N1M1G3 с метастазами в кости скелета, лимфоузлы шеи, левый надпочечник. Хирургическое лечение из-за распространенности не выполнялось. Проведено 6 циклов полихимиотерапии по схеме доксорубицин + ифосфамид. По данным ПЭТ/КТ получена частичная регрессия опухоли. Заключение. Радиационно-индуцированная саркома мягких тканей является ятрогенным поздним осложнением лучевой терапии по поводу лимфомы Ходжкина. Опухоль возникла в зоне облучения. ПЭТ/КТ является методом выбора в диагностике и оценке распространенности процесса и ответа на лечение. Химиотерапия как опция комплексного лечения позволяет достичь адекватного контроля течения болезни при невозможности выполнения хирургического метода.
Background. Radiation-induced malignancies are one of the long-term complications of radiation therapy, which is widely used to treat some tumors. The latency period before a second tumor develops varies from 3 to 60 years. Epithelial tumors and hemoblastoses occur after low-dose radiation therapy and sarcomas after high-dose radiation therapy. Aim. To present a case of radiation-induced soft tissue angiosarcoma of the neck after the cure of Hodgkin's disease. Materials and methods. A 41-year-old patient with Hodgkin's nodular lymphoma with the lymphoid predominance of stage IIIA with involvement of the right cervical and clavicular lymph nodes, mediastinum, and abdominal lymph nodes was followed-up. In 2004 the patient underwent four cycles of polychemotherapy per ABVD regimen followed by radiotherapy of the right cervical and clavicular lymph nodes and mediastinum, with a total focal dose of 40 Gy. Results. Seventeen years after the treatment for Hodgkin's disease, including radiation therapy, the patient presented with painful swelling of the neck soft tissues in the radiation area with the transition to the anterior thoracic wall and an enlarged cervical lymph node. A lymph node dissection was performed. According to the combined positron emission tomography and X-ray computed tomography (PET/CT), histological and immunohistochemical studies, epithelioid angiosarcoma of soft tissues of the neck and thoracic wall stage IV cT2N1M1G3 with metastases to the skeleton bones, neck lymph nodes, left adrenal gland was established. Surgical treatment was not performed due to advanced disease. The patient received six cycles of polychemotherapy with doxorubicin + ifosfamide. PET/CT confirmed partial tumor regression. Conclusion. Radiation-induced soft tissue sarcoma is a late iatrogenic complication of radiation therapy for Hodgkin's lymphoma. The tumor occurred in the radiation area. PET/CT is the method of choice in diagnosing and evaluating the extent of cancer and response to treatment. Chemotherapy, as an option for complex treatment, can achieve adequate disease control when surgery is not feasible.
1. Kumar S. Second malignant neoplasms following radio-therapy. Int J Environ Res Public Health. 2012;9(12):4744-59.
2. Singh GK, Yadav V, Singh P, Bhowmik KT. Radiation-Induced Malignancies Making Radiotherapy a “Two-Edged Sword”: A Review of Literature. World J Oncol. 2017;8(1):1-6.
3. Dineen SP, Roland CL, Feig R, et al. Radiation-associated undifferentiated pleomorphic sarcoma is associated with worse clinical outcomes than sporadic lesions. Ann Surg Oncol. 2015;22:3913-20.
4. Kim KS, Chang JH, Choi N, et al. Radiation-induced sarcoma: A 15-year experience in a single large tertiary referral center. Cancer Res Treat. 2016;48:650-7.
5. Cahan WG, Woodard HQ, Higinbotham NL, et al. Sarcoma in irradiated bone. Report of eleven cases. Cancer. 1948:3-29. DOI:10.1002/1097-0142(194805)1:1<3::AID-CNCR2820010103>3.0.CO;2-7
6. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56:83-8. DOI:10.1016/S0360-3016(03)00073-7
7. Travis LB, Hill DA, Dores GM, et al. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA. 2003;290:465‑75. DOI:10.1001/jama.290.4.465
8. Berrington de Gonzalez A, Gilbert E, Curtis R, et al. Second solid cancers after radiotherapy: a systematic review of the epidemiological studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys. 2013;86:1-19. DOI:10.1016/j.ijrobp.2012.09.001
9. Yang Q, Mo Y, Zhao Q, et al. Radiation-induced sarcomas of the head and neck in post-radiation nasopharyngeal carcinoma. Radiol Med. 2017;122:53-60.
DOI:10.1007/s11547-016-0695-5
10. Sklar C, Whitton J, Mertens A, et al. Abnormalities of the Thyroid in Survivors of Hodgkin’s Disease: Data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab. 2000;85(9):3227032. DOI:10.1210/jcem.85.9.6808
11. Sale KA, Wallace DI, Girod DA, Tsue TT. Radiation-induced malignancy of the head and neck. Otolaryngol Head Neck Surg. 2004;131:643-5. DOI:10.1016/j.otohns.2004.05.012
12. Patel SG, See AC, Williamson PA, et al. Radiation induced sarcoma of the head and neck. Head Neck. 1999;21:346-54. DOI:10.1002/(SICI)1097-0347(199907)21:4<346::AID-HED9>3.0.CO;2-B
13. Dores GM, Metayer C, Curtis RE, et al. Second malignant neoplasms among long-term survivors of Hodgkin's disease: a population-based evaluation over 25 years. J Clin Oncol. 2002;20:3484-94. DOI:10.1200/JCO.2002.09.038
14. van Eggermond AM, Schaapveld M, Lugtenburg PJ. Risk of multiple primary malignancies following treatment of Hodgkin lymphoma. Blood. 2014;124(3):319‑27.
DOI:10.1182/blood-2013-10-532184
15. O’Brien MM, Donaldson SS, Balise RR, et al. Second malignant neoplasms in survivors of pediatric Hodgkin’s lymphoma treated with low-dose radiation and chemotherapy. J Clin Oncol. 2010;28:1232-9. DOI:10.1200/JCO.2009.24.8062
16. Šalaševičius L, Vaitkevičienė GE, Pasaulienė R, et al. Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab. Medicina (Kaunas). 2020;56(4):155. DOI:10.3390/medicina56040155
17. Kry SF, Followill D, White RA, et al. Uncertainty of calculated risk estimates for secondary malignancies after radiotherapy. Int J Radiat Oncol Biol Phys. 2007;68:1265-71. DOI:10.1016/j.ijrobp.2007.04.014
18. Johansen S, Cozzi L, Olsen DR. A planning comparison of dose patterns in organs at risk and predicted risk for radiation induced malignancy in the contralateral breast following radiation therapy of primary breast using conventional, IMRT and volumetric modulated arc treatment techniques. Acta Oncol. 2009;48:495‑503. DOI:10.1080/02841860802657227
19. Weber DC, Peguret N, Dipasquale G, et al. Involved-node and involved field volumetric modulated arc vs. fixed beam intensity-modulated radiotherapy for female patients with early-stage supra-diaphragmatic Hodgkin lymphoma: A comparative planning study. Int J Rad Oncol Biol Phys. 2009;75:1578-86.
20. Hodgson DC, Koh ES, Tran TH, et al. Individualized estimates of second cancer risks after contemporary radiation therapy for Hodgkin lymphoma. Cancer. 2007;110:2576-86.
21. Weber DC, Johanson S, Peguret N, et al. Predicted Risk of Radiation-Induced Cancers After Involved Field and Involved Node Radiotherapy With or Without Intensity Modulation for Early-Stage Hodgkin Lymphoma in Female Patients. Int J Radiat Oncol Biol Phys. 2011;81(2):490-7. DOI:10.1016/j.ijrobp.2010.05.035
22. Cai PQ, Wu YP, Li L, et al. CT and MRI of radiation-induced sarcomas of the head and neck following radiotherapy for nasopharyngeal carcinoma. Clin Radiol. 2013;68:683-9. DOI:10.1016/j.crad.2013.01.004
23. Wei Z, Xie Y, Xu J, et al. Radiation-induced sarcoma of head and neck: 50 years of experience at a single institution in an endemic area of nasopharyngeal carcinoma in China. Med Oncol. 2012;29:670-6. DOI:10.1007/s12032-011-9828-9
24. Coca-Pelaz A, Mäkitie AA, Strojan P, et al. Radiation-Induced Sarcomas of the Head and Neck: A Systematic Review. Adv Ther. 2021;38:90-108. DOI:10.1007/s12325-020-01556-y
25. Mito JK, Mitra D, Barysauskas CM, et al. A Comparison of Outcomes and Prognostic Features for Radiation-Associated Angiosarcoma of the Breast and Other Radiation-Associated Sarcomas. Int J Radiat Oncol Biol Phys. 2019;104(2):425-35. DOI:10.1016/j.ijrobp.2019.01.082
26. Ng AK, Mauch PM. Late effects of Hodgkin’s disease and its treatment. Cancer J. 2009;15:164-8. DOI:10.1097/PPO.0b013e31819e30d7
27. Morton LM. Triple jeopardy for Hodgkin lymphoma survivors? Blood. 2014;124(3):309-10. DOI:10.1182/blood-2014-05-571646
28. Schellong G, Riepenhausen M, Creutzig U, et al. Low risk of secondary leukemias after chemotherapy without mechlorethamine in childhood Hodgkin's disease: German-Austrian Pediatric Hodgkin's Disease Group. J Clin Oncol. 1997;15:2247-53.
29. Toda K, Shibuya H, Hayashi K, Ayukawa F. Radiation-induced cancer after radiotherapy for non-Hodgkin’s lymphoma of the head and neck: a retrospective study. Radiat Oncol. 2009;4(1):21. DOI:10.1186/1748-717x-4-21
30. Debnam JM, Guha-Thakurta N, Mahfouz YM, et al. Radiation-associated head and neck sarcomas: Spectrum of imaging findings. Oral Oncol. 2012;48:155-61. DOI:10.1016/j.oraloncology.2011.08.017
31. Rosko AJ, Birkeland AC, Chinn SB, et al. Survival and margin status in head and neck radiation-induced sarcomas and de novo sarcomas. Otolaryngol Head Neck Surg. 2017;157:252-9. DOI:10.1177/0194599817700389
32. Zhu W, Hu F, Zhao T, et al. Clinical characteristics of radiation-induced sarcoma of the head and neck: review of 15 cases and 323 cases in the literature. J Oral Maxillofac Surg. 2016;74:283-91. DOI:10.1016/j.joms.2015.07.013
33. Xu XG, Bednarz B, Paganetti H. A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction. Phys Med Biol. 2014;53:1-58. DOI:10.1088/0031-9155/53/13/R01
________________________________________________
1. Kumar S. Second malignant neoplasms following radio-therapy. Int J Environ Res Public Health. 2012;9(12):4744-59.
2. Singh GK, Yadav V, Singh P, Bhowmik KT. Radiation-Induced Malignancies Making Radiotherapy a “Two-Edged Sword”: A Review of Literature. World J Oncol. 2017;8(1):1-6.
3. Dineen SP, Roland CL, Feig R, et al. Radiation-associated undifferentiated pleomorphic sarcoma is associated with worse clinical outcomes than sporadic lesions. Ann Surg Oncol. 2015;22:3913-20.
4. Kim KS, Chang JH, Choi N, et al. Radiation-induced sarcoma: A 15-year experience in a single large tertiary referral center. Cancer Res Treat. 2016;48:650-7.
5. Cahan WG, Woodard HQ, Higinbotham NL, et al. Sarcoma in irradiated bone. Report of eleven cases. Cancer. 1948:3-29. DOI:10.1002/1097-0142(194805)1:1<3::AID-CNCR2820010103>3.0.CO;2-7
6. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56:83-8. DOI:10.1016/S0360-3016(03)00073-7
7. Travis LB, Hill DA, Dores GM, et al. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA. 2003;290:465‑75. DOI:10.1001/jama.290.4.465
8. Berrington de Gonzalez A, Gilbert E, Curtis R, et al. Second solid cancers after radiotherapy: a systematic review of the epidemiological studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys. 2013;86:1-19. DOI:10.1016/j.ijrobp.2012.09.001
9. Yang Q, Mo Y, Zhao Q, et al. Radiation-induced sarcomas of the head and neck in post-radiation nasopharyngeal carcinoma. Radiol Med. 2017;122:53-60.
DOI:10.1007/s11547-016-0695-5
10. Sklar C, Whitton J, Mertens A, et al. Abnormalities of the Thyroid in Survivors of Hodgkin’s Disease: Data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab. 2000;85(9):3227032. DOI:10.1210/jcem.85.9.6808
11. Sale KA, Wallace DI, Girod DA, Tsue TT. Radiation-induced malignancy of the head and neck. Otolaryngol Head Neck Surg. 2004;131:643-5. DOI:10.1016/j.otohns.2004.05.012
12. Patel SG, See AC, Williamson PA, et al. Radiation induced sarcoma of the head and neck. Head Neck. 1999;21:346-54. DOI:10.1002/(SICI)1097-0347(199907)21:4<346::AID-HED9>3.0.CO;2-B
13. Dores GM, Metayer C, Curtis RE, et al. Second malignant neoplasms among long-term survivors of Hodgkin's disease: a population-based evaluation over 25 years. J Clin Oncol. 2002;20:3484-94. DOI:10.1200/JCO.2002.09.038
14. van Eggermond AM, Schaapveld M, Lugtenburg PJ. Risk of multiple primary malignancies following treatment of Hodgkin lymphoma. Blood. 2014;124(3):319‑27.
DOI:10.1182/blood-2013-10-532184
15. O’Brien MM, Donaldson SS, Balise RR, et al. Second malignant neoplasms in survivors of pediatric Hodgkin’s lymphoma treated with low-dose radiation and chemotherapy. J Clin Oncol. 2010;28:1232-9. DOI:10.1200/JCO.2009.24.8062
16. Šalaševičius L, Vaitkevičienė GE, Pasaulienė R, et al. Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab. Medicina (Kaunas). 2020;56(4):155. DOI:10.3390/medicina56040155
17. Kry SF, Followill D, White RA, et al. Uncertainty of calculated risk estimates for secondary malignancies after radiotherapy. Int J Radiat Oncol Biol Phys. 2007;68:1265-71. DOI:10.1016/j.ijrobp.2007.04.014
18. Johansen S, Cozzi L, Olsen DR. A planning comparison of dose patterns in organs at risk and predicted risk for radiation induced malignancy in the contralateral breast following radiation therapy of primary breast using conventional, IMRT and volumetric modulated arc treatment techniques. Acta Oncol. 2009;48:495‑503. DOI:10.1080/02841860802657227
19. Weber DC, Peguret N, Dipasquale G, et al. Involved-node and involved field volumetric modulated arc vs. fixed beam intensity-modulated radiotherapy for female patients with early-stage supra-diaphragmatic Hodgkin lymphoma: A comparative planning study. Int J Rad Oncol Biol Phys. 2009;75:1578-86.
20. Hodgson DC, Koh ES, Tran TH, et al. Individualized estimates of second cancer risks after contemporary radiation therapy for Hodgkin lymphoma. Cancer. 2007;110:2576-86.
21. Weber DC, Johanson S, Peguret N, et al. Predicted Risk of Radiation-Induced Cancers After Involved Field and Involved Node Radiotherapy With or Without Intensity Modulation for Early-Stage Hodgkin Lymphoma in Female Patients. Int J Radiat Oncol Biol Phys. 2011;81(2):490-7. DOI:10.1016/j.ijrobp.2010.05.035
22. Cai PQ, Wu YP, Li L, et al. CT and MRI of radiation-induced sarcomas of the head and neck following radiotherapy for nasopharyngeal carcinoma. Clin Radiol. 2013;68:683-9. DOI:10.1016/j.crad.2013.01.004
23. Wei Z, Xie Y, Xu J, et al. Radiation-induced sarcoma of head and neck: 50 years of experience at a single institution in an endemic area of nasopharyngeal carcinoma in China. Med Oncol. 2012;29:670-6. DOI:10.1007/s12032-011-9828-9
24. Coca-Pelaz A, Mäkitie AA, Strojan P, et al. Radiation-Induced Sarcomas of the Head and Neck: A Systematic Review. Adv Ther. 2021;38:90-108. DOI:10.1007/s12325-020-01556-y
25. Mito JK, Mitra D, Barysauskas CM, et al. A Comparison of Outcomes and Prognostic Features for Radiation-Associated Angiosarcoma of the Breast and Other Radiation-Associated Sarcomas. Int J Radiat Oncol Biol Phys. 2019;104(2):425-35. DOI:10.1016/j.ijrobp.2019.01.082
26. Ng AK, Mauch PM. Late effects of Hodgkin’s disease and its treatment. Cancer J. 2009;15:164-8. DOI:10.1097/PPO.0b013e31819e30d7
27. Morton LM. Triple jeopardy for Hodgkin lymphoma survivors? Blood. 2014;124(3):309-10. DOI:10.1182/blood-2014-05-571646
28. Schellong G, Riepenhausen M, Creutzig U, et al. Low risk of secondary leukemias after chemotherapy without mechlorethamine in childhood Hodgkin's disease: German-Austrian Pediatric Hodgkin's Disease Group. J Clin Oncol. 1997;15:2247-53.
29. Toda K, Shibuya H, Hayashi K, Ayukawa F. Radiation-induced cancer after radiotherapy for non-Hodgkin’s lymphoma of the head and neck: a retrospective study. Radiat Oncol. 2009;4(1):21. DOI:10.1186/1748-717x-4-21
30. Debnam JM, Guha-Thakurta N, Mahfouz YM, et al. Radiation-associated head and neck sarcomas: Spectrum of imaging findings. Oral Oncol. 2012;48:155-61. DOI:10.1016/j.oraloncology.2011.08.017
31. Rosko AJ, Birkeland AC, Chinn SB, et al. Survival and margin status in head and neck radiation-induced sarcomas and de novo sarcomas. Otolaryngol Head Neck Surg. 2017;157:252-9. DOI:10.1177/0194599817700389
32. Zhu W, Hu F, Zhao T, et al. Clinical characteristics of radiation-induced sarcoma of the head and neck: review of 15 cases and 323 cases in the literature. J Oral Maxillofac Surg. 2016;74:283-91. DOI:10.1016/j.joms.2015.07.013
33. Xu XG, Bednarz B, Paganetti H. A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction. Phys Med Biol. 2014;53:1-58. DOI:10.1088/0031-9155/53/13/R01
Авторы
Н.А. Огнерубов*1,2, Т.С. Антипова3
1 ФГБОУ ВО «Тамбовский государственный университет им. Г.Р. Державина», Тамбов, Россия;
2 ГБУЗ «Тамбовский областной онкологический клинический диспансер», Тамбов, Россия;
3 Центр ядерной медицины ООО «ПЭТ-Технолоджи», Тамбов, Россия
*ognerubov_n.a@mail.ru
________________________________________________
Nikolai A. Ognerubov*1,2, Tatiana S. Antipova3
1 Derzhavin Tambov State University, Tambov, Russia;
2 Tambov Regional Oncological Clinical Dispensary, Tambov, Russia;
3 PET-Technology, Tambov, Russia
*ognerubov_n.a@mail.ru