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Title: Alveolar soft part sarcoma following radiotherapy for a spinal hemangioma. A case report

Abstract

A case of alveolar soft part sarcoma arising some 20 years later in a site previously irradiated as a treatment for a spinal cord hemangioma is described. This is the first known case of radiation-associated alveolar soft part sarcoma, and it fulfills the criteria for a tumor to be radiation-induced. The coincidental finding of ''viral-like'' particles within some of the tumor cells was noted.

Authors:
; ;
Publication Date:
Research Org.:
UCLA Medical Center
OSTI Identifier:
6539248
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cancer (Philadelphia); (United States); Journal Volume: 53:12
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; ANGIOMAS; RADIOTHERAPY; LUNGS; SARCOMAS; SIDE EFFECTS; RADIOINDUCTION; SPINAL CORD; DELAYED RADIATION EFFECTS; LATENCY PERIOD; PATIENTS; BIOLOGICAL EFFECTS; BIOLOGICAL RADIATION EFFECTS; BODY; CENTRAL NERVOUS SYSTEM; DISEASES; MEDICINE; NEOPLASMS; NERVOUS SYSTEM; NUCLEAR MEDICINE; ORGANS; RADIATION EFFECTS; RADIOLOGY; RESPIRATORY SYSTEM; THERAPY; 560151* - Radiation Effects on Animals- Man

Citation Formats

Wang, S., Mirra, J., and Bhuta, S.. Alveolar soft part sarcoma following radiotherapy for a spinal hemangioma. A case report. United States: N. p., 1984. Web. doi:10.1002/1097-0142(19840615)53:12<2655::AID-CNCR2820531214>3.0.CO;2-Z.
Wang, S., Mirra, J., & Bhuta, S.. Alveolar soft part sarcoma following radiotherapy for a spinal hemangioma. A case report. United States. doi:10.1002/1097-0142(19840615)53:12<2655::AID-CNCR2820531214>3.0.CO;2-Z.
Wang, S., Mirra, J., and Bhuta, S.. 1984. "Alveolar soft part sarcoma following radiotherapy for a spinal hemangioma. A case report". United States. doi:10.1002/1097-0142(19840615)53:12<2655::AID-CNCR2820531214>3.0.CO;2-Z.
@article{osti_6539248,
title = {Alveolar soft part sarcoma following radiotherapy for a spinal hemangioma. A case report},
author = {Wang, S. and Mirra, J. and Bhuta, S.},
abstractNote = {A case of alveolar soft part sarcoma arising some 20 years later in a site previously irradiated as a treatment for a spinal cord hemangioma is described. This is the first known case of radiation-associated alveolar soft part sarcoma, and it fulfills the criteria for a tumor to be radiation-induced. The coincidental finding of ''viral-like'' particles within some of the tumor cells was noted.},
doi = {10.1002/1097-0142(19840615)53:12<2655::AID-CNCR2820531214>3.0.CO;2-Z},
journal = {Cancer (Philadelphia); (United States)},
number = ,
volume = 53:12,
place = {United States},
year = 1984,
month = 6
}
  • This combined ultrastructural and immunohistochemical study of four alveolar soft-part sarcomas analyzes the characteristic granules in order to elucidate the histogenesis of this unusual neoplasm. The granules have the ultrastructural features and staining characteristics of renin, react with antiserum to renin, and like renin, incorporate zinc into the crystalline storage granules. The cell appears to be a modified smooth muscle cell analogous to renal juxtaglomerular cells and the cells of juxtaglomerular cell tumors. As there is no association with hypertension, it would appear that alveolar soft-part sarcomas either do not secrete or the product is a form of renin thatmore » does not act upon the angiotensin system.« less
  • Purpose: To examine the relationship between tumor location, bone dose, and irradiated bone length on the development of radiation-induced fractures for lower extremity soft tissue sarcoma (LE-STS) patients treated with limb-sparing surgery and radiotherapy (RT). Methods and Materials: Of 691 LE-STS patients treated from 1989 to 2005, 31 patients developed radiation-induced fractures. Analysis was limited to 21 fracture patients (24 fractures) who were matched based on tumor size and location, age, beam arrangement, and mean total cumulative RT dose to a random sample of 53 nonfracture patients and compared for fracture risk factors. Mean dose to bone, RT field sizemore » (FS), maximum dose to a 2-cc volume of bone, and volume of bone irradiated to >=40 Gy (V40) were compared. Fracture site dose was determined by comparing radiographic images and surgical reports to fracture location on the dose distribution. Results: For fracture patients, mean dose to bone was 45 +- 8 Gy (mean dose at fracture site 59 +- 7 Gy), mean FS was 37 +- 8 cm, maximum dose was 64 +- 7 Gy, and V40 was 76 +- 17%, compared with 37 +- 11 Gy, 32 +- 9 cm, 59 +- 8 Gy, and 64 +- 22% for nonfracture patients. Differences in mean, maximum dose, and V40 were statistically significant (p = 0.01, p = 0.02, p = 0.01). Leg fractures were more common above the knee joint. Conclusions: The risk of radiation-induced fracture appears to be reduced if V40 <64%. Fracture incidence was lower when the mean dose to bone was <37 Gy or maximum dose anywhere along the length of bone was <59 Gy. There was a trend toward lower mean FS for nonfracture patients.« less
  • Purpose: Adjuvant radiotherapy has during the past decades become increasingly used in the treatment of localized soft tissue sarcoma. We evaluated the effect of radiotherapy (RT) on local recurrence rates (LRRs) in Scandinavia between 1986 and 2005. Methods and Materials: A total of 1,093 adult patients with extremity or trunk wall soft tissue sarcoma treated at four Scandinavian sarcoma centers were stratified according to the treatment period (1986-1991, 1992-1997, and 1998-2005). The use of adjuvant RT, quality of the surgical margin, interval between surgery and RT, and LRR were analyzed. The median follow-up was 5 years. Results: The use ofmore » RT (77% treated postoperatively) increased from 28% to 53%, and the 5-year LRR decreased from 27% to 15%. The rate of wide surgical margins did not increase. The risk factors for local recurrence were histologic high-grade malignancy (hazard ratio [HR], 5), an intralesional (HR, 6) or marginal (HR, 3) surgical margin, and no RT (HR, 3). The effect of RT on the LRR was also significant after a wide margin resection and in low-grade malignant tumors. The LRR was the same after preoperative and postoperative RT. The median interval from surgery to the start of RT was 7 weeks, and 98% started RT within 4 months. The LRR was the same in patients who started treatment before and after 7 weeks. Conclusion: The results of our study have shown that adjuvant RT effectively prevents local recurrence in soft tissue sarcoma, irrespective of the tumor depth, malignancy grade, and surgical margin status. The effect was most pronounced in deep-seated, high-grade tumors, even when removed with a wide surgical margin.« less
  • Objective: To develop a Radiation Therapy Oncology Group (RTOG) atlas delineating gross tumor volume (GTV) and clinical target volume (CTV) to be used for preoperative radiotherapy of primary extremity soft tissue sarcoma (STS). Methods and Materials: A consensus meeting was held during the RTOG meeting in January 2010 to reach agreement about GTV and CTV delineation on computed tomography (CT) images for preoperative radiotherapy of high-grade large extremity STS. Data were presented to address the local extension of STS. Extensive discussion ensued to develop optimal criteria for GTV and CTV delineation on CT images. Results: A consensus was reached onmore » appropriate CT-based GTV and CTV. The GTV is gross tumor defined by T1 contrast-enhanced magnetic resonance images. Fusion of magnetic resonance and images is recommended to delineate the GTV. The CTV for high-grade large STS typically includes the GTV plus 3-cm margins in the longitudinal directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm, including any portion of the tumor not confined by an intact fascial barrier, bone, or skin surface. Conclusion: The consensus on GTV and CTV for preoperative radiotherapy of high-grade large extremity STS is available as web-based images and in a descriptive format through the RTOG. This is expected to improve target volume consistency and allow for rigorous evaluation of the benefits and risks of such treatment.« less
  • Purpose: To evaluate adjuvant chemotherapy and interpolated accelerated radiotherapy (RT) for adult patients with high-risk soft tissue sarcoma in the extremities or trunk wall. Methods and Materials: High-risk soft tissue sarcoma was defined as high-grade malignancy and at least two of the following criteria: size {>=}8 cm, vascular invasion, or necrosis. Six cycles of doxorubicin and ifosfamide were prescribed for all patients. RT to a total dose of 36 Gy (1.8 Gy twice daily) was inserted between two chemotherapy cycles after marginal margin resection regardless of tumor depth or after wide-margin resection for deep-seated tumors. RT was boosted to 45more » Gy in a split-course design in the case of intralesional margin resection. Results: A total of 119 patients were eligible, with a median follow-up of 5 years. The 5-year estimate of the local recurrence, metastasis-free survival, and overall survival rate was 12%, 59%, and 68%, respectively. The group receiving RT to 36 Gy had a local recurrence rate of 10%. In contrast, the local recurrence rate was 29% in the group treated with RT to 45 Gy. The presence of vascular invasion and low chemotherapy dose intensity had a negative effect on metastasis-free and overall survival. Toxicity was moderate after both the chemotherapy and the RT. Conclusions: Accelerated RT interposed between chemotherapy cycles in a selected population of patients with high-risk soft tissue sarcoma resulted in good local and distant disease control, with acceptable treatment-related morbidity. The greater radiation dose administered after intralesional surgery was not sufficient to compensate for the poorer surgical margin. Vascular invasion was the most important prognostic factor for metastasis-free and overall survival.« less