Postradiation sarcoma after radiotherapy for nasopharyngeal carcinoma.
OBJECTIVE
Postradiation sarcoma (PRS) is a notorious complication after radiotherapy (RT). The prognosis is poor, and the role of surgery is not well defined. The aim of our study was to review our experience in the management of PRS after RT for nasopharyngeal carcinoma (NPC).


METHODS
Case series.


METHODS
Between 1998 and 2011, all patients treated for PRS after radiation for NPC were reviewed retrospectively.


RESULTS
Twenty-five patients were included. The mean latency period for the development of PRS after previous RT was 12.4 years. The histologic subtypes included osteosarcoma (n = 8), rhabdomyosarcoma (n = 6), undifferentiated sarcoma (n = 6), malignant fibrous histiocytoma (n = 4), and leiomyosarcoma (n = 1). Twenty patients underwent surgery with curative intent, but 14 of them eventually had microscopic positive resection margins. Among them, all received postoperative adjuvant chemoradiation, and six of them had brachytherapy as well. However, 71.4% of them eventually developed local recurrence. The median survival was significantly better for those with clear margin resection than for those with positive margins (5.12 years vs. 1.44 years, P = .04). Surgery was effective in symptom palliation, including tumor pain, bleeding, and trismus.


CONCLUSIONS
PRS remains a disease with poor prognosis. Surgical resection with clear margins achieves significantly better survival. Surgery is also effective in the palliation of pain, bleeding, and trismus in patients with advanced staged disease.
Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China. chanjyw@gmail.com
Jimmy Yu Wai
JY
Chan
Stanley Thian Sze
ST
Wong
Gregory Ian Siu Kee
GI
Lau
William Ignace
WI
Wei
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma; D003937:Diagnosis, Differential; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed