POSTIRRADIATION SARCOMA OF THE GYNECOLOGIC TRACT - REPORT OF 13 CASESAND A DISCUSSION OF THE RISK OF RADIATION-INDUCED GYNECOLOGIC MALIGNANCIES

With improvement in survival after cancer treatment, it is becoming in creasingly important to examine treatment-related morbidity and mortal ity. Sarcomas can develop within the irradiated field after radiation therapy (RT) for gynecologic malignancies. We undertook a study to ass ess the outcome after treatment of postirradiation sarcoma (PIS) of th e gynecologic tract. In reviewing our data and the literature, we comp are the absolute risk of PIS and other radiation-associated second mal ignant neoplasms (SMNs) with the mortality risk of surgery and general anesthesia. Between 1955 and 1987, 114 patients with uterine sarcomas were seen at the University of California, Los Angeles (UCLA), Medica l Center. Thirteen had a prior history of RT. Conditions for which the se patients received RT included choriocarcinoma (one), menorraghia (f our), cervical cancer (six), and ovarian cancer (two). RT doses were k nown in six cases and ranged from 4,000 to 8,000 cGy. Latency time fro m RT to the development of PIS ranged from 3 to 30 years, with a media n of 17 years. Twelve patients were treated with surgery or additional RT. Two patients remain alive 5 months and 57 months, respectively, f ollowing salvage therapy. Five-year disease-specific survival for all patients is 17%. From our data and a review of the literature, we esti mate that the absolute risk of PIS with long-term follow-up ranges fro m 0.03 to 0.8%. Postirradiation sarcoma of the gynecologic tract is a relatively rare event associated with a poor prognosis. Mortality risk s of radiation-associated SMN are similar to mortality risks of surger y and general anesthesia; Given the large number of patients with gyne cologic malignancies who can be cured or palliated with RT, concern re garding radiation sarcomagenesis should not be a major factor influenc ing treatment decisions.