Postradiation sarcoma after radiotherapy for nasopharyngeal carcinoma

Abstract

OBJECTIVES/HYPOTHESIS: 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). STUDY DESIGN: 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.