RESUMEN
BACKGROUND: Radiotherapy associated with chemotherapy is a well-established treatment modality for locally advanced non-small cell lung cancers. Radiation-induced second malignancies, particularly radiation-induced sarcomas, are rare. Some authors reported a recent increase in the incidence of this rare complication, especially because of the improved prognosis and survival of patients after radiotherapy. Pathogenic mechanisms of radiation-induced sarcomas are poorly understood. However, diagnosis criteria are well established. Treatment options must be discussed and adapted to the patient's profile. Surgery in irradiated tissue is challenging, with limited treatment options with chemotherapy and radiotherapy. CASE PRESENTATION: We report the case of a 62-year-old Moroccan man diagnosed as having chondrosarcoma of his right scapula, who was irradiated 10 years ago for stage IIIB non-small cell lung cancer. This case was managed by a complete resection of the tumor with good functional and oncological outcomes. To the best of our knowledge, the scapular location of radiation-induced sarcoma after irradiation for lung cancer has never been described in the literature. CONCLUSION: Radiation-induced sarcoma of the scapula represents a rare situation that must be actively researched to have access to an optimal therapeutic approach.
Asunto(s)
Neoplasias Óseas , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Condrosarcoma , Neoplasias Pulmonares/radioterapia , Neoplasias Inducidas por Radiación , Escápula , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/patología , Condrosarcoma/patología , Condrosarcoma/cirugía , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/patología , Cintigrafía , Dosificación Radioterapéutica , Escápula/patología , Escápula/efectos de la radiación , Escápula/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: The study focuses on the comparison of tissue reaction to titanium and bioresorbable implants with and without postoperative irradiation on an animal model. MATERIALS AND METHODS: Thirty-nine LEW/W rats were randomly assigned to experimental or control groups. One titanium and one bioresorbable screw (poly-L-lactide [PLLA] and L- and D-lactide poly-L/D-lactide [PDLLA]) were implanted into the left scapulas of 24 rats. Half of them received 30 Gy to the operation site and the other half received 42 Gy. In the control groups, 3 rats received 30 Gy, and 6 rats received 42 Gy to the scapula area without operation; and 6 rats had implants inserted as in the experimental group, but received no postoperative irradiation. The scapulas were removed 14 or 30 days after irradiation and a histologic analysis was performed. RESULTS: The host tissue reaction to titanium and PLLA-PDLLA screws without postoperative irradiation was of similar intensity. In irradiated animals, the inflammatory tissue reaction was more evident around the titanium screws than around the bioresorbable screws, irrespective of the radiation dose and of the time that elapsed from the irradiation. The reaction was more evident on the 14th day than on the 30th day after the last radiation dose (70 and 86 days after surgery, respectively). The intensity of the inflammatory tissue reaction, irrespective of the implant type, was more intense in the group irradiated with 42 Gy. CONCLUSIONS: PLLA-PDLLA implants appear to cause less tissue reaction after irradiation and could be safer reconstructive devices than titanium implants for patients undergoing surgery and adjuvant radiotherapy for cancer.
Asunto(s)
Tornillos Óseos , Dosis de Radiación , Escápula/efectos de la radiación , Escápula/cirugía , Implantes Absorbibles , Animales , Masculino , Oseointegración/efectos de la radiación , Osteogénesis/efectos de la radiación , Proyectos Piloto , Poliésteres , Distribución Aleatoria , Ratas , Ratas Endogámicas Lew , Propiedades de Superficie , TitanioRESUMEN
The patient was a 62-year-old male who underwent wide resection and radiotherapy for right scapular chondrosarcoma 12 years ago. An abnormal shadow was detected in the right upper lung field included in the irradiated field on chest X-ray. Since the nodule tended to enlarge, a malignant lung tumor was suspected, and surgery was performed. On histological examination, spindle cells densely proliferated in a bundle pattern. Vimentin, bcl-2 protein, and CD99 were positive, and CD34, cytokeratin, AE1/AE3, and EMA were partially positive on immunohistochemical staining. The SYT-SSX (synaptotagmin- synovial sarcoma X) fusion gene was detected employing RT-PCR, based on which primary synovial sarcoma of the lung was diagnosed. The findings also matched the diagnostic criteria of radiation-induced sarcoma, suggesting radiation-induced primary synovial sarcoma of the lung. Primary synovial sarcoma of the lung is a rare tumor. It is difficult to diagnose based on cellular findings, and immunohistochemical and genetic investigations are essential. Radiation-induced sarcoma may develop through a long-term course, as seen in this patient, for which long-term follow-up after radiotherapy is important.
Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias Óseas/terapia , Condrosarcoma/terapia , Perfilación de la Expresión Génica , Neoplasias Pulmonares/genética , Neoplasias Inducidas por Radiación/genética , Proteínas de Fusión Oncogénica/genética , Sarcoma Sinovial/genética , Escápula , Biomarcadores de Tumor/análisis , Neoplasias Óseas/radioterapia , Neoplasias Óseas/cirugía , Condrosarcoma/radioterapia , Condrosarcoma/cirugía , Perfilación de la Expresión Génica/métodos , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/química , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/química , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/cirugía , Reacción en Cadena de la Polimerasa , Valor Predictivo de las Pruebas , Dosificación Radioterapéutica , Radioterapia Adyuvante , Sarcoma Sinovial/química , Sarcoma Sinovial/etiología , Sarcoma Sinovial/cirugía , Escápula/efectos de la radiación , Escápula/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Recurrencia Local de Neoplasia/cirugía , Reimplantación/métodos , Escápula/efectos de la radiación , Escápula/trasplante , Acondicionamiento Pretrasplante/métodos , Adulto , Anciano , Biopsia con Aguja , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Recurrencia Local de Neoplasia/diagnóstico , Osteocondroma/diagnóstico , Osteocondroma/cirugía , Dosis de Radiación , Procedimientos de Cirugía Plástica/métodos , Medición de Riesgo , Articulación del Hombro/patología , Articulación del Hombro/cirugía , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: Evaluation of MRI in radiotherapy of humeroscapular periarthritis. PATIENTS AND METHODS: Seventy-seven patients with humeroscapular periarthritis prospectively underwent MRI before radiotherapy. RESULTS: Six months after radiotherapy, 34% of the patients had achieved complete pain relief, 35% major pain relief. Twenty percent had only slight improvement and 12% no improvement. Positive correlation of radiotherapy outcome and MRI findings could be shown for acute tendinitis, erosions, and complete and incomplete ruptures of the supraspinatus tendon. CONCLUSIONS: Radiotherapy is highly effective in the treatment of humeroscapular periarthritis. The indication can be improved using MRI.
Asunto(s)
Periartritis/radioterapia , Fotones/uso terapéutico , Articulación del Hombro/efectos de la radiación , Anciano , Campos Electromagnéticos , Femenino , Estudios de Seguimiento , Humanos , Húmero/efectos de la radiación , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Escápula/efectos de la radiación , Resultado del TratamientoRESUMEN
A case of radiation induced osteonecrosis resulting in a fracture of the scapula in a 76-yr-old female patient with a history of breast carcinoma is presented. Diagnostic imaging, laboratory recommendations and clinical findings are discussed along with an algorithm for the safe management of patients with a history of cancer and musculoskeletal complaints. This case demonstrates the necessity of a thorough investigation of musculoskeletal complaints in patients with previous bone-seeking carcinomas.
Asunto(s)
Fracturas Espontáneas/etiología , Osteorradionecrosis/complicaciones , Escápula/efectos de la radiación , Anciano , Femenino , Fracturas Espontáneas/diagnóstico por imagen , Humanos , Cintigrafía , Escápula/lesiones , Tomografía Computarizada por Rayos XRESUMEN
An improvement is achieved by palliative X-ray irradiation in about 70% out of 47 patients with scapulohumeral periarthritis and local cervical syndrome and/or cervicobrachial syndrome which was hitherto resistant to medicomechanical treatment. Higher rates of success (84%) can be achieved if the patients present an identical symptomatology, but less severe alterations of the vertebral column, even if the vertebral column is not irradiated. In case of severe alterations of the vertebral column, the success of palliative irradiation is diminished, even if the cervical vertebral column is additionally irradiated.