Post-radiation Osteosarcomas of the Jaws and a Review of the Literature

Abstract

Patients with a primary malignancy have a 1.29 times increased risk for developing a second malignancy compared to people with no history of malignancy. Radiation is an effective treatment for malignancies but is also known to induce tumor formation. The most common radiation induced sarcomas (RIS) include fibrosarcoma, chondrosarcoma, malignant fibrous histiocytoma and osteosarcoma. Radiation induced sarcomas of the head and neck are rare and are associated with poor long-term prognosis. The most common sites in the head and neck are the paranasal sinuses and nasal cavity, neck and mandible. Cahan's criteria for diagnosis of radiation induced sarcomas include history of radiation, latency period of several years, occurrence of sarcoma in the field of irradiation, and histologic confirmation. An approximate dose of 30Gy is known to induce RIS. A latency period of 10-12 years is supported by the literature. Between the years of 1986 to 2020 the Oral Pathology Lab at New York Presbyterian Queens diagnosed 29 cases of osteosarcoma, 10 cases of chondrosarcoma, and 9 cases of MFH. Only 6 of the 48 sarcoma cases were radiation induced and all of them were osteosarcomas. The mean age of the 6 osteosarcomas was 52.83 years. All our cases were in males. Based on past medical history 5 of the cases received radiation for squamous cell carcinoma and 1 for Hodgkin Lymphoma. Of the 4 cases with documented radiation timelines, a mean latency period of 11.87 years was identified. The submitting surgeons suspected malignancy in 5 cases based on clinical appearance. The literature states RIS usually occurs in bone, however, 5 of our cases occurred in soft tissue within the radiation field. Histologically, cases showed malignant spindle cells producing osteoid matrix except case 1 in which the tumor cells embedded in eosinophilic hyalinized stroma demonstrated SATB2 nuclear expression, supporting osseous differentiation.