EARLY ONSET OF RADIATION INDUCED SARCOMA: A CASE REPORT AND REVIEW OF THE LITE- RATURE

NILGUN YILDIRIM¹, MELIH SIMSEK², MEHMET TURKELI², MEHMET BILICI², HILAL KIZILTUNC OZMEN³

¹Department of Medical Oncology, Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey - ²Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey - ³Department of Radiation Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey

Introduction: Radiation induced sarcoma (RIS) is a long-term complication of radiation therapy. Its incidence, 5 years after treatment, is 0.03-0.2%. This risk is related to radiation dose, concomitant alkylating agents and genetic factors.

Case presentation: We report the case of a 33-year-old woman with synchronous gastric (adenocarcinoma, intestinal type, T3N2M0, Stage 3A) and right-sided breast cancer (invasive ductal carcinoma (IDC), T2N1M0, Cerb2 (+++), Stage 2B) who recei- ved postoperative adjuvant chemotherapy (CT) and radiotherapy (RT) to stomach and breast. At the 22nd month after RT, pleo- morphic undifferentiated sarcoma was diagnosed at the right thoracic wall including axillary region (field of RT) synchronously with the left sided breast cancer. After adjuvant CT, first she received chemo-radiotherapy (CRT) for gastric cancer. After that she received complex RT to breast region (right supraclavicular fossa single front plan, tangential fields bolus), a total of 5000 cGy as 200 cGy/day X 25 fractions to right chest wall and a total dose as 5000 cGy to posterior axillary region. During follow-up, a 3 cm lesion at right axilla and a BIRADS 4A lesion in her left breast were determined. Sarcoma in right axilla and IDC in left breast were repor- ted after biopsy. Patient underwent surgery at the same session.

Conclusion: Although post-radiation sarcomas are rare complications with poor prognosis, enhanced awareness and early detection by clinicians are essential to improve outcomes via curative surgical resection. Latent period is expressed with years, but in our case RIS was developed after a short time with 22 months.