title: An unexpected skin ulcer and soft tissue necrosis after the nonconcurrent combination of proton beam therapy and pazopanib: A case of myxofibrosarcoma.
abstract: We herein report the case of a patient presenting with myxofibrosarcoma (MFS) who underwent treatment with surgery, proton beam therapy (PBT), and pazopanib. A 64-year-old male was diagnosed with MFS, which ranged from the posterior neck to the shoulder. Surgery was performed as an initial treatment; however, the primary tumor recurred 83 months after the initial treatment. We, therefore, administered PBT. Although most of the recurrent tumor disappeared after PBT, multiple lung metastases were identified 3 months after the completion of PBT. We initiated antiangiogenic treatment with pazopanib. Although long-term survival was achieved with the treatments, the patient suffered from a skin ulcer and soft tissue necrosis and eventually died of general prostration caused by infection, and complicated by pneumonia. Although PBT and pazopanib were effective for treating the local recurrence and lung metastases of MFS, respectively, clinicians must be cognizant of the fact that the combination of high-dose irradiation and angiogenesis inhibitors, even in nonconcurrent cases, can result in a severe skin ulcer and soft tissue necrosis.
authors: Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: nobu-uwa@hyo-med.ac.jp.
authors: Nobuhiro
authors: N
authors: Uwa
authors: Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors: Tomonori
authors: T
authors: Terada
authors: Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors: Takeshi
authors: T
authors: Mohri
authors: Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors: Yoshitane
authors: Y
authors: Tsukamoto
authors: Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors: Hiroyuki
authors: H
authors: Futani
authors: Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan.
authors: Yusuke
authors: Y
authors: Demizu
authors: Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan.
authors: Tomoaki
authors: T
authors: Okimoto
authors: Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors: Masafumi
authors: M
authors: Sakagami
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D003646:Debridement; D017809:Fatal Outcome; D005354:Fibrosarcoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007191:Indazoles; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000000981:diagnostic imaging / Q000628:therapy*; D009336:Necrosis / Q000139:chemically induced; D061766:Proton Therapy / Q000009:adverse effects*; D011743:Pyrimidines / Q000009:adverse effects*; D012883:Skin Ulcer / Q000139:chemically induced* / Q000628:therapy; D018461:Soft Tissue Infections; D013449:Sulfonamides / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D020533:Angiogenesis Inhibitors; D007191:Indazoles; D011743:Pyrimidines; D013449:Sulfonamides; C516667:pazopanib
keywords: Head and neck; Myxofibrosarcoma; Pazopanib; Proton beam therapy