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Radiation-associated sarcomas

Robert Maki, MD, PhD
Section Editors
Thomas F DeLaney, MD
Alberto S Pappo, MD
Raphael E Pollock, MD
Deputy Editor
Diane MF Savarese, MD


Improvements in therapy for a variety of malignancies have led to increasing numbers of people who are long-term cancer survivors. Survivors of both adult and childhood cancers are at risk for developing therapy-related complications, including second cancers, now aptly termed an "iatrogenic disease of success" [1]. (See "Overview of cancer survivorship care for primary care and oncology providers", section on 'Epidemiology of cancer survivors'.)

Therapeutic radiation has long been recognized as an inducing agent in the development of malignant neoplasms [2-5]. The first case reports of bone sarcomas in patients who had received radiation therapy (RT) for benign bone conditions were published in 1922, and a report of bone sarcomas in the jaws of radium-dial painters followed in 1929 [6,7].

Sarcomas are rare malignant tumors that arise from mesenchymal tissues at any location. The histopathologic spectrum of sarcomas is broad, reflecting the fact that the embryonic mesenchymal cells from which they arise have the capacity to mature into striated skeletal and smooth muscle, adipose and fibrous tissue, bone, and cartilage. (See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma", section on 'Histopathology'.)

Besides exposure to RT, pathogenetic factors include genetic predisposition, exposure to chemotherapy, and for certain types of soft tissue sarcoma, chronic edema, and viral infection. (See "Pathogenetic factors in soft tissue and bone sarcomas".)

This topic review will cover secondary soft tissue and bone sarcomas that arise after therapeutic irradiation in adults and children. Other radiation-associated malignancies (eg, thyroid cancer, acute and chronic myelogenous leukemia, breast and lung cancer, and secondary malignancies following hematopoietic cell transplantation) as well as an overview of the consequences of unintended radiation exposure, and the risk of malignancy due to diagnostic imaging are covered elsewhere.

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Literature review current through: Oct 2017. | This topic last updated: Dec 01, 2016.
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