Radiation-induced sarcoma in patients with nasopharyngeal carcinoma: a single-institution retrospective study
-
摘要: 目的 分析鼻咽癌在放射治疗后出现的头颈部放射性诱发肉瘤(radiation-induced sarcoma，RIS)的临床发病特点、治疗方式及预后，探讨其治疗策略。方法 回顾2013年1月-2022年10月在广西壮族自治区人民医院治疗的鼻咽癌RIS患者。描述其发生时间、发生部位、病理亚型、影像学特征及治疗结果，随访统计总生存期水平。结果 本研究纳入10例患者，鼻咽癌和RIS之间的间隔时间为2~27年，RIS好发于鼻咽部，病理学类型以骨肉瘤为主。总体中位生存期18个月，联合化疗组中位生存期40个月，单纯手术组的中位生存期12个月。1年及2年的累积生存率分别为48%和36%。预后分析显示性别、发病年龄、放疗后肉瘤发生时间、治疗情况与临床预后无明确相关性，骨肉瘤较其他病理类型预后更差。结论 RIS是鼻咽癌患者最严重的远期不良反应。RIS预后差，手术完全切除肿瘤可提高患者的生存率，在手术无法完全切除肿瘤的情况下，放疗或者化疗可能有助于改善预后。Abstract: Objective To analyze the clinical features, treatment methods and prognosis of radiation-induced sarcoma(RIS) of the head and neck after radiotherapy for nasopharyngeal carcinoma(NPC), and explore its treatment strategies.Methods A retrospective analysis was conducted on RIS patients after radiotherapy for NPC in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2013 to October 2022. The time of onset, lesion location, pathological subtypes, imaging features and treatment outcomes were described, and the median survival time was statistically analyzed through follow-up.Results This study included 10 patients with an interval of 2-27 years between NPC and RIS. The nasopharynx was the more common site of RIS, and osteosarcoma was the main pathological type. The median overall survival was 18 months. The median survival was 40 months in the surgery combined with the chemotherapy group, and 12 months in the surgery alone group. The 1-and 2-year cumulative survival rates were 48% and 36%, respectively. Prognostic analysis showed that gender, age of onset, time of sarcoma onset after radiotherapy and treatment methods might not be influencing factors for prognosis, and osteosarcomas presented a poorer prognosis than other pathological types.Conclusion RIS is one of the most severe long-term adverse effects in patients with NPC. The prognosis of RIS is poor, and complete surgical resection of the tumor can improve patient survival rates. In cases where complete surgical resection is challenging, radiotherapy or chemotherapy may offer some improvement in tumor control.
-
Key words:
- nasopharyneal carcinoma /
- sarcoma /
- radiotherapy /
- surgical procedures
-
-
表 1 10例鼻咽癌放疗后肉瘤预后的单因素分析
因素 例数 生存率/% χ2 P 1年 2年 性别 0.132 0.716 男 6 48 48 女 4 67 50 年龄 2.863 0.091 ≥55岁 5 12 0 ＜55岁 5 80 60 鼻咽癌和RIS间隔期 0.030 0.862 ＜15年 4 50 25 ≥15年 6 46 46 病理类型 4.331 0.037 骨肉瘤 4 25 0 非骨肉瘤 6 65 65 治疗情况 3.198 0.074 单纯手术治疗 6 29 0 手术联合化疗 4 75 75 
下载: 导出CSV
-
[1] Chen YP, Chan ATC, Le QT, et al. Nasopharyngeal carcinoma[J]. Lancet, 2019, 394(10192): 64-80. doi: 10.1016/S0140-6736(19)30956-0
[2] 瞿申红, 翁敬锦, 韦嘉章. 广西地区鼻咽癌防治概况与展望[J]. 中国临床新医学, 2021, 14(7): 633-641. doi: 10.3969/j.issn.1674-3806.2021.07.01
[3] Cahan WG, Woodard HQ, Higinbotham NL, et al. Sarcoma arising in irradiated bone: report of eleven cases. 1948[J]. Cancer, 1998, 82(1): 8-34. doi: 10.1002/(SICI)1097-0142(19980101)82:1<8::AID-CNCR3>3.0.CO;2-W
[4] Murray EM, Werner D, Greeff EA, et al. Postradiation sarcomas: 20 cases and a literature review[J]. Int J Radiat Oncol Biol Phys, 1999, 45(4): 951-961. doi: 10.1016/S0360-3016(99)00279-5
[5] Mark RJ, Poen J, Tran LM, et al. Postirradiation sarcomas. A single-institution study and review of the literature[J]. Cancer, 1994, 73(10): 2653-2562. doi: 10.1002/1097-0142(19940515)73:10<2653::AID-CNCR2820731030>3.0.CO;2-G
[6] Chen WY, Lu SH, Wang YM, et al. Post-irradiation sarcoma after definitive radiation therapy for nasopharyngeal carcinoma[J]. Radiother Oncol, 2023, 178: 109423. doi: 10.1016/j.radonc.2022.11.012
[7] Thiagarajan A, Iyer NG. Radiation-induced sarcomas of the head and neck[J]. World J Clin Oncol, 2014, 5(5): 973-981. doi: 10.5306/wjco.v5.i5.973
[8] Zhang AY, Judson I, Benson C, et al. Chemotherapy with radiotherapy influences time-to-development of radiation-induced sarcomas: a multicenter study[J]. Br J Cancer, 2017, 117(3): 326-331. doi: 10.1038/bjc.2017.198
[9] Neuhaus SJ, Pinnock N, Giblin V, et al. Treatment and outcome of radiation-induced soft-tissue sarcomas at a specialist institution[J]. Eur J Surg Oncol, 2009, 35(6): 654-659. doi: 10.1016/j.ejso.2008.11.008
[10] Samartzis D, Nishi N, Hayashi M, et al. Exposure to ionizing radiation and development of bone sarcoma: new insights based on atomic-bomb survivors of Hiroshima and Nagasaki[J]. J Bone Joint Surg Am, 2011, 93(11): 1008-1015. doi: 10.2106/JBJS.J.00256
[11] Samartzis D, Nishi N, Cologne J, et al. Ionizing radiation exposure and the development of soft-tissue sarcomas in atomic-bomb survivors[J]. J Bone Joint Surg Am, 2013, 95(3): 222-229. doi: 10.2106/JBJS.L.00546
[12] Filippi AR, Vanoni V, Meduri B, et al. Intensity Modulated Radiation Therapy and Second Cancer Risk in Adults[J]. Int J Radiat Oncol Biol Phys, 2018, 100(1): 17-20. doi: 10.1016/j.ijrobp.2017.09.039
[13] Echchikhi Y, Loughlimi H, Touil A, et al. Radiation-induced osteosarcoma of the skull base after radiation therapy in a patient with nasopharyngeal carcinoma: acase report and review of theliterature[J]. J Med Case Rep, 2016, 10(1): 334. doi: 10.1186/s13256-016-1112-3
[14] 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[J]. Clin Radiol, 2013, 68(7): 683-689. doi: 10.1016/j.crad.2013.01.004
[15] Debnam JM, Guha-Thakurta N, Mahfouz YM, et al. Radiation-associated head and neck sarcomas: spectrum of imaging findings[J]. Oral Oncol, 2012, 48(2): 155-161. doi: 10.1016/j.oraloncology.2011.08.017
[16] Wood J, Ver Halen J, Samant S, et al. Radiation-induced sarcoma masquerading as osteoradionecrosis: case report and literature review[J]. J Laryngol Otol, 2015, 129(3): 279-282. doi: 10.1017/S0022215114003326
[17] Patel AJ, Rao VY, Fox BD, et al. Radiation-induced osteosarcomas of the calvarium and skull base[J]. Cancer, 2011, 117(10): 2120-2126. doi: 10.1002/cncr.25734
[18] Onishi S, Yamasaki F, Kinoshita Y, et al. Characteristics and therapeutic strategies of brain and cranial radiation-induced sarcoma: analysis of 165 cases from our case experience and comprehensive review[J]. Jpn J Clin Oncol, 2023, 53(10): 905-911. doi: 10.1093/jjco/hyad078
[19] Bjerkehagen B, Småstuen MC, Hall KS, et al. Why do patients with radiation-induced sarcomas have a poor sarcoma-related survival?[J]. Br J Cancer, 2012, 106(2): 297-306. doi: 10.1038/bjc.2011.559
[20] Gladdy RA, Qin LX, Moraco N, et al. Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas?[J]. J Clin Oncol, 2010, 28(12): 2064-2069. doi: 10.1200/JCO.2009.25.1728
[21] Wei-wei L, Qiu-liang W, Guo-hao W, et al. Clinicopathologic features, treatment, and prognosis of postirradiation osteosarcoma in patients with nasopharyngeal cancer[J]. Laryngoscope, 2005, 115(9): 1574-1579. doi: 10.1097/01.mlg.0000173166.48440.e4
[22] Lou J, Jiang L, Dai X, et al. Radiation-Induced Sarcoma of the Head and Neck Following Radiotherapy for Nasopharyngeal Carcinoma: A Single Institutional Experience and Literature Review[J]. Front Oncol, 2021, 10: 526360. doi: 10.3389/fonc.2020.526360
[23] Chan JY, Wong ST, Lau GI, et al. Postradiation sarcoma after radiotherapy for nasopharyngeal carcinoma[J]. Laryngoscope, 2012, 122(12): 2695-2699. doi: 10.1002/lary.23282
[24] 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]. J Oral Maxillofac Surg, 2016, 74(2): 283-291. doi: 10.1016/j.joms.2015.07.013
[25] Giannini L, Incandela F, Fiore M, et al. Radiation-Induced Sarcoma of the Head and Neck: A Review of the Literature[J]. Front Oncol, 2018, 8: 449. doi: 10.3389/fonc.2018.00449
[26] Thijssens KM, van Ginkel RJ, Suurmeijer AJ, et al. Radiation-induced sarcoma: a challenge for the surgeon[J]. Ann Surg Oncol, 2005, 12(3): 237-245. doi: 10.1245/ASO.2005.03.041
[27] Callesen LB, Safwat A, Rose HK, et al. Radiation-Induced Sarcoma: A Retrospective Population-Based Study Over 34 Years in a Single Institution[J]. Clin Oncol(R Coll Radiol), 2021, 33(5): e232-e238. doi: 10.1016/j.clon.2020.12.009
[28] 张焕康, 张明, 蒋晓文, 等. 颏下瓣在鼻咽癌手术修复中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(7): 506-509, 514. doi: 10.13201/j.issn.2096-7993.2022.07.005
[29] Patel R, Hu J, Chopra S, et al. Neoadjuvant chemotherapy for radiation-associated soft-tissue sarcoma: A case report[J]. Rare Tumors, 2019, 11: 2036361318821763.
[30] Liao LQ, Yan HH, Mai JH, et al. Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma[J]. Chin J Cancer, 2016, 35(1): 89. doi: 10.1186/s40880-016-0153-8
-
计量
- 文章访问数: 85
- 施引文献: 0