Radiation‐induced sarcomas of the chest wall
Radiation‐induced sarcomas of the chest wall
复制标题
放射诱发的胸壁肉瘤
作者：
M. S. W. W. SOUBA;MD ROBERT J. MCKENNA JR;MD JEANNE MEIS;MD ROBERT BENJAMIN;MD A. KEVIN RAYMOND;A. C. F. Mountain
16 名患者的胸壁肉瘤位于先前接受过恶性肿瘤治疗的部位。第一批恶性肿瘤包括乳腺癌（十例）、霍奇金病（四例）和其他癌症（两例）。辐射剂量从 4200 到 5500 R（平均 4900 R）不等。潜伏期5～28年（平均13年）。放射肉瘤的组织学类型如下：恶性纤维组织细胞瘤9例；骨肉瘤6例；恶性间叶瘤1例。唯一的长期幸存者在锁骨软骨母细胞骨肉瘤切除术后 12 年仍健康地活着。最近诊断出三例病例。尽管采取了积极的多学科治疗，其余 13 名患者仍全部死于肉瘤（平均生存期为 13.5 个月）。所有患者的最初恶性肿瘤显然都被治愈了。化疗无效。包括前肢截肢在内的任何治疗似乎都无法缓解锁骨上软组织肉瘤患者的症状。大面积胸壁切除术为八名胸骨或侧胸壁肉瘤患者中的七名提供了良好的姑息治疗。需要密切随访，以在越来越多接受治疗性放射治疗的患者中检测这些肉瘤的迹象。
Sixteen patients are presented who had sarcomas of the chest wall at a site where a prior malignancy had been irradiated. The first malignancies included breast cancer (ten cases), Hodgkin's disease (four cases), and others (two cases). Radiation doses varied from 4200 to 5500 R (mean, 4900 R). The latency period ranged from 5 to 28 years (mean, 13 years). The histologic types of the radiation‐induced sarcomas were as follows: malignant fibrous histiocytoma, nine cases; osteosarcoma, six cases; and malignant mesenchymoma, one case. The only long‐term survivor is alive and well 12 years after resection of a clavicular chondroblastic osteosarcoma. Three cases were recently diagnosed. Despite aggressive multimodality treatment, the remaining 13 patients have all died from their sarcomas (mean survival, 13.5 months). All patients have apparently been cured of their first malignancies. Chemotherapy was ineffective. No treatment, including forequarter amputation, appeared to palliate the patients with supraclavicular soft tissue sarcomas. Major chest wall resection offered good palliation for seven of eight patients with sarcomas arising in the sternum or lateral chest wall. Close follow‐up is needed to detect signs of these sarcomas in the ever‐increasing number of patients receiving therapeutic irradiation.