POSTIRRADIATION SARCOMA OF THE HEAD AND NECK

Background. With improvement in survival after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Sarcoma can develop in the irradiated field after radia tion therapy. The authors performed a study to estimate the risk, and compared the risk of sarcoma after radiation therapy with that of othe r treatment modalities used against cancer. Methods. Between 1955 and 1988, 229 patients with sarcoma of the head and neck were seen at the University of California, Los Angeles (UCLA), Medical Center. Of these , 13 (6%) had a previous history of radiation therapy to the head and neck. Results. Radiation doses were known in 10 of 13 patients and ran ged from 30 to 124.4 Gy. The latency time from radiation therapy to th e development of postirradiation sarcoma (PIS) ranged from 3 months to 50 years, with a median of 12 years. More than 2000 patients have rec eived radiation therapy to the head and neck for various conditions at the UCLA Medical Center since 1955. Conclusions. The authors conclude that most head and neck sarcomas are not radiation related and that t he risk of PIS after head and neck irradiation for other diseases is l ow. From a review of the literature comparing mortality risks of chemo therapy, general surgery, and anesthesia, the risk of PIS appears no w orse. Given the large number of patients who can be cured or receive p alliation with radiation therapy, concern about PIS should not be a ma jor factor influencing treatment decisions in patients with cancer.