title: Radiation-induced sarcoma: a challenge for the surgeon.
abstract: BACKGROUND
  Treatment of radiation-induced sarcoma (RIS) remains an unsolved problem. To provide more insight into the disease process, its characteristics, outcome, and potential outcome determinants were defined.
  
  
  METHODS
  From 1978 to 2003, 27 patients--20 females (74%) and 7 males (26%) with a median age 44 years (range, 1-73 years) at the time of diagnosis of the primary tumor--developed an RIS after a median interval of 8 years (range, 3-41 years). The histology of the RIS was 10 (37%) undifferentiated high-grade pleomorphic sarcomas, 7 (26%) angiosarcomas, 6 (22%) fibrosarcomas, 2 (7%) osteosarcomas, 1 (4%) pleomorphic rhabdomyosarcoma, and 1 (4%) pleomorphic leiomyosarcoma. Surgical resection was performed in 21 patients: 13 (62%) R0 (microscopically radical), 4 (19%) R1 (microscopically irradical), 2 (9.5%) R2 (macroscopically irradical), and 2 (9.5%) RX (unknown radicality). Six (22%) patients underwent no resection.
  
  
  RESULTS
  The 5-year disease-free and overall survival rates were 27% and 30%, respectively. The local failure rate after R0 resection was 54%. The distant failure rate for the entire group was 41%. Patients with an R0 resection had a significantly better survival rate (P < .05) than patients with an R1, R2, or no resection.
  
  
  CONCLUSIONS
  RISs are aggressive malignancies with a high tendency for local recurrence and distant metastases. Previously applied treatment often hampers adequate resection. Therefore, radical surgical resection is the only chance to improve disease-free and overall survival, but it may also have a palliative role. Still, the overall prognosis remains poor.
authors.affiliation: Department of Surgical Oncology, Groningen University Medical Centre, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Katja M J
authors.initials: KM
authors.lastname: Thijssens
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Ginkel
authors.forename: Albert J H
authors.initials: AJ
authors.lastname: Suurmeijer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pras
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: Miranda
authors.initials: M
authors.lastname: Hollander
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009381:Neoplasms, Radiation-Induced / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000209:etiology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome