Radiation-induced Osteosarcoma Research Articles

Human osteosarcoma cells in response to ELF-MF: Morphological remodeling compared to cell proliferation.

The present study aimed to assess the effects of extremely low-frequency electromagnetic fields (ELF-MF) on structural changes of human osteosarcoma cells by analyzing the stained cytoskeleton for assessing the relationship between the fractal dimension parameter and proliferation rate of radiation-induced cells. In this study, 2-mT magnetic fields with various waveforms, including sinusoidal, triangular, and pulsed shapes, were employed to determine the biological effects of ELF-EMF on the human osteosarcoma MG-63 cell line. All experiments were performed in two modes: continuous exposure at 3 h and fractionated irradiations at 3 consecutive days. Afterward, the proliferation assay was implemented for assessing the cell proliferation in each group. Moreover, immunofluorescence staining and confocal imaging were performed to determine the cell shape index. Furthermore, fractal dimension analysis was carried out by processing morphological images. The proliferation and shape index parameters of radiation-induced osteosarcomas significantly decreased compared with non-irradiated cells. In addition, fractal dimensions significantly increased following fractionated exposure at 3 consecutive days. Assessing the fractal dimensions can be considered as a new morphological index for the prognosis of the structural remodeling of human osteosarcoma cells in response to fractionated irradiation of ELF-MF. In addition, various waveforms induce a similar effect on morphological remodeling and cell proliferation.

Short Latency Radiation Induced Osteosarcoma Detected on 18F-FDG PET/CT Scan in Solitary Plasmacytoma.

18Fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays a pivotal role in the staging, restaging, and surveillance of various bone tumors, including plasmacytomas and osteosarcomas. Solitary plasmacytomas most frequently occur in the bones and are primarily treated with either surgery or radiotherapy. Radiation-induced osteosarcomas (RIOS) usually develop after a median interval of 11 years between radiation and sarcoma presentation. However, these can rarely present with a short latent period of 4 years or even lesser. In such cases, whole-body imaging plays a vital role in the early detection and management of RIOS. Herein, we present the case of a 29-year-old female patient with solitary plasmacytoma undergoing a follow-up whole-body 18F-FDG PET/CT, which revealed metastatic RIOS after a short latent period.

Radiation-induced osteosarcoma in the pubic bone after proton radiotherapy for prostate cancer: a case report

Objective: Radiation-induced sarcoma (RIS), which develops after radiotherapy, occurs as a secondary sarcoma in the irradiated area after a long latency period following radiation exposure.Patient: A 59-year-old man underwent hormone therapy for prostate cancer, followed by proton therapy (74 GyE) four years ago. Positron emission tomography/computed tomography performed 2.5 years later revealed 18F-FDG accumulation in the left pubis. Three years after proton therapy, the patient developed gradually worsening left inguinal pain and visited our department. Imaging revealed bone destruction with a mixture of osteolysis and osteogenesis in the left pubis and the presence of an extraosseous tumor. Following biopsy, the patient was diagnosed with osteosarcoma.Results: A systemic investigation revealed lung metastasis, and chemotherapy was initiated. The lung metastases shrank, and carbon ion radiotherapy (CIRT, 70.4 GyE) was performed on the left pubic lesion after colostomy. Six months after carbon ion radiotherapy, recurrence was observed in the irradiated field, and CIRT was performed again. However, the patient died 22 months after the initial diagnosis because of cancerous pleurisy and pericarditis.Conclusions: Although RIS is rare, it should be actively identified using biopsy to confirm the diagnosis, keeping in mind that it is an important late complication of radiotherapy.

Advanced cervical cancer in young women: imaging study of late and very late radiation-related side effects after successful treatment by combined radiotherapy

Radical combined radiotherapy (RT) is a standard treatment for advanced cervical cancer. The aim of our study was to identify morphological late (≥6 months) and very late (≥5 years) radiation-related comorbidities on computed tomography (CT), positron emission tomography/computerized tomography (PET/CT) or magnetic resonance imaging (MRI) scans in young females who survived ≥5 years since RT and were considered as successfully treated. Secondly, we studied a rate of clinically silent radiation-related toxicities apparent on imaging scans that might influenced on future well-being of survived females. Thirdly, we analyzed reasons why patients underwent imaging scans. We included 41 subjects aged under 50 years (mean 41.8±7.2 years, median 41 years), who survived ≥5 years since RT, with at least one available imaging scan ≥3 years since RT. The mean time between RT and the last available scan was 12.3±7.9 years (median 9 years); the mean time of clinical follow-up was 15.4±7.1 years (median 14 years). Fourteen (34.1%) females underwent the first imaging scan in emergency situation and 27 (65.9%) patients due to variable chronic complaints. Grade III-V radiation-related comorbidities occurred in 19 (46.3%) females including one case of death due to radiation-induced osteosarcoma. In 14 of 19 patients, comorbidities were multiple. Four (9.8%) females suffered from life-threatening complications (grade IV): one from an uretero-arterial fistula with massive hematuria and 3 from bowel perforations. Eleven (26.8%) subjects suffered from bowel strictures with ileus development, they underwent mean 1.7±0.8 surgery (median 1.5). The mean time since RT to the first surgery for intestinal complications was 5.4±6.0 years (median 3 years), to the second 12.0±9.6 years (median 11.5 years) and to the third surgery 9.0±4.2 years (median 9 years). Late fistulas formations (vesico-recto-vaginal) were seen in 6 (14.6%) patients. Bone complications were diagnosed in 9 (22.0%) of treated females, one case of osteosarcoma included, 4 of 9 bone complications were clinically silent. In 5 (12.2%) subjects, toxicities grade III-IV first time manifested >5 years since RT, majority of them were multiple. The bowel perforation and fistulas formations were the earliest manifested grade III-IV toxicities, with median time 3 years since RT, the bone complications were the latest manifested with median time 16 years since RT. Our study is not able to bring information about the incidence of late and very late radiation related comorbidities, according to International Federation of Gynecology and Obstetrics (FIGO) recommendations patients are clinically followed only for 5 years and imaging cross-sectional scans are not recommended. However, our study shows that if females successfully treated for advanced cervical cancer report abdominal/pelvic clinical problems, it is highly probable their imaging scans will reveal late radiation related side-effects that may affect the rest of their life. It puts forward question whether females after radical RT should been regularly followed by cross-sectional imaging methods.

Fatal high-grade skull osteosarcoma 30 years following radiotherapy for Cushing's disease.

SummaryCushing’s disease is a rare disorder characterised by excessive cortisol production as a consequence of a corticotroph pituitary tumour. While the primary treatment is surgical resection, post-operative radiation therapy may be used in cases of ongoing inadequate hormonal control or residual or progressive structural disease. Despite improved outcomes, radiotherapy for pituitary tumours is associated with hypopituitarism, visual deficits and, rarely, secondary malignancies. We describe an unusual case of a 67-year-old female with presumed Cushing’s disease diagnosed at the age of 37, treated with transsphenoidal resection of a pituitary tumour with post-operative external beam radiotherapy (EBRT), ketoconazole for steroidogenesis inhibition, and finally bilateral adrenalectomy for refractory disease. She presented 30 years after her treatment with a witnessed generalised tonic-clonic seizure. Radiological investigations confirmed an extracranial mass infiltrating through the temporal bone and into brain parenchyma. Due to recurrent generalised seizures, the patient was intubated and commenced on dexamethasone and anti-epileptic therapy. Resection of the tumour revealed a high-grade osteoblastic osteosarcoma. Unfortunately, the patient deteriorated in intensive care and suffered a fatal cardiac arrest following a likely aspiration event. We describe the risk factors, prevalence and treatment of radiation-induced osteosarcoma, an exceedingly rare and late complication of pituitary irradiation. To our knowledge, this is the longest reported latency period between pituitary irradiation and the development of an osteosarcoma of the skull.Learning points:Cushing’s disease is treated with transsphenoidal resection as first-line therapy, with radiotherapy used in cases of incomplete resection, disease recurrence or persistent hypercortisolism.The most common long-term adverse outcome of pituitary tumour irradiation is hypopituitarism occurring in 30–60% of patients at 10 years, and less commonly, vision loss and oculomotor nerve palsies, radiation-induced brain tumours and sarcomas.Currently proposed characteristics of radiation-induced osteosarcomas include: the finding of a different histological type to the primary tumour, has developed within or adjacent to the path of the radiation beam, and a latency period of at least 3 years.Treatment of osteosarcoma of the skull include complete surgical excision, followed by systemic chemotherapy and/or radiotherapy.Overall prognosis in radiation-induced sarcoma of bone is poor.Newer techniques such as stereotactic radiosurgery may reduce the incidence of radiation-induced malignancies.

Radiation-Induced Osteosarcoma in the Cervical Spine after Definitive Radiotherapy for Esophageal Cancer: A Case Report.

Radiation-Induced Osteosarcoma in the Cervical Spine after Definitive Radiotherapy for Esophageal Cancer: A Case Report.

Radiation-Induced Maxillary Osteosarcoma: A Case Report

Osteosarcoma (OS) is the most common primary bone malignant tumor [1]. Although pathogenesis is unknown, various...

Secondary Osteosarcoma of Pelvic Bone: Long-Term Complication of Bladder Cancer Radiotherapy

AbstractSecond cancer in the irradiated area is one of the complication of radiotherapy of which bone and soft tissue sarcomas predominate. Radiation-induced osteosarcoma (RIOS)accounts for 3.4%–5.5% of all osteosarcoma cases. A 70-year old male presented with complaints of swelling and pain in left gluteal region without any antecedent trauma. On clinical examination 8 × 8 cm size swelling palpable in left gluteal region arising form left iliac bone. He had history of bladder carcinoma 20 years ago for which he received concurrent chemoradiation. CT scan showed a large, erosive and lytic lesion of left iliac bone and biopsy of the lesion was suggestive of osteosarcoma. In view of extensive lesion eroding left half of pelvic bone, surgery was not done, and chemotherapy was planned.

Radiation-Induced Intrapelvic Osteosarcoma Treated with Radical Pelvic Surgery: Case Report and Literature Review

Radiation-Induced Intrapelvic Osteosarcoma Treated with Radical Pelvic Surgery: Case Report and Literature Review

Radiation-induced osteosarcoma of the calvarium in a patient of left frontal oligodendroglioma following surgery and radiotherapy

Radiation-induced osteosarcoma of the calvarium in a patient of left frontal oligodendroglioma following surgery and radiotherapy

RETRACTED: Overexpression of GRIM-19 accelerates radiation-induced osteosarcoma cells apoptosis by p53 stabilization

AimsOsteosarcoma is one of the most aggressive types of primary bone cancer that responds poorly to radiotherapy frequently. The gene associated with retinoid-interferon mortality (GRIM-19) is a tumor suppressor that mediates cell apoptosis in multiple cancer types. However, the role of GRIM-19 in osteosarcoma and the underlying mechanism remain unclear. This study was designed to investigate the role and the underlying mechanism of GRIM-19 in osteosarcoma progression. Materials and methodsOsteosarcoma tissues and cell lines were utilized to analyze the expressions of GRIM-19 in osteosarcoma by qRT-PCR and Western blot. Methods containing flow cytometry, irradiation exposure, cells inoculation, plasmid transfection, and protein immunoprecipitation were used to investigate the underlying mechanisms of GRIM-19 in osteosarcoma progression. Key findingsGRIM-19 is downregulated in osteosarcoma tissues and cell lines. Exposure to radiation induces osteosarcoma cell apoptosis by upregulation of p53 both in U2OS (p53-wt) and exogenous p53-introduced MG-63 (p53-null) osteosarcoma cells. Overexpression of GRIM-19 accelerates radiation-induced osteosarcoma cells apoptosis by p53 stabilization ex vivo and in vivo. Mechanistically, forced expression of GRIM-19 diminishes the activity of E3 ubiquitin-protein ligase mouse double minute 2 homolog (MDM2), a specific p53 protease, results in the accumulation of p53 and activation of p53-mediated apoptosis. SignificanceGRIM-19 was proved to modulate radiation-induced osteosarcoma cells apoptosis in a p53 dependent manner by mediating MDM2 activity, which sheds light on the development of GRIM-19-based molecular target therapy on osteosarcoma.

Video‐assisted microwave ablation for the treatment of a metastatic lung lesion in a dog with appendicular osteosarcoma and hypertrophic osteopathy

To describe video-assisted microwave ablation (VAMA) for the treatment of a metastatic lung lesion secondary to right forelimb osteosarcoma in a dog. Case report. A 10-year-old female spayed mixed breed dog with a metastatic lung lesion secondary to appendicular osteosarcoma. An osteosarcoma of the right distal scapula and proximal humerus that was suspected to be a radiation-induced osteosarcoma was treated with limb amputation and carboplatin chemotherapy. The patient developed pulmonary metastatic lesions and hypertrophic osteopathy (HO). VAMA of a metastatic lesion in the right caudal lung lobe was performed 227 days after amputation. The procedure was performed without complication. Follow-up information with the referring veterinarian 40 days after VAMA indicated that the patient was stable and that the clinical signs of HO had resolved. Thoracic radiographs taken by the referring veterinarian (RDVM) at monthly intervals showed that the previously treated metastatic lesion was stable. At 134 days from VAMA, the patient presented to the RDVM for lethargy and dyspnea and was transferred to an emergency clinic. The patient arrested and died 136 days from the VAMA procedure while hospitalized. A postmortem was not performed. VAMA for pulmonary metastatic lesions is technically feasible and allows for the treatment of symptoms associated with HO and minimally invasive management of pulmonary metastases in the case reported.

Radiation-Induced Maxillary Osteosarcoma and Synchronous Oropharyngeal Squamous Cell Cancer: A Rare Case Report

Radiation-Induced Maxillary Osteosarcoma and Synchronous Oropharyngeal Squamous Cell Cancer: A Rare Case Report

Radiation-Induced Maxillary Osteosarcoma and Synchronous Oropharyngeal Squamous Cell Cancer: A Rare Case Report

Radiotherapy is a treatment option for nasopharyngeal cancer. However, ionizing radiation may lead to development of secondary malignancies. In this case report, we will present a case of radiation-induced osteosarcoma of the maxilla and synchronous oropharyngeal squamous cell cancer following treatment of nasopharyngeal cancer. History, latency period, physical examinations, computed tomography, magnetic resonance imaging and biopsy results are provided. Diagnosis was confirmed by excision biopsy. Radiation-induced tumors are possible long-term side effects of radiotherapy. Although rare and possible to confuse with recurrent disease, this possibility should be considered in any patient who has received radiation therapy. Diagnostic imaging plays a pivotal role in recognition of radiation induced neoplastic disease. Accurate identification and reporting of key imaging findings allows referring physicians to choose the most appropriate treatment options.

A Case of Radiation Induced Osteosarcoma of Proximal Humerus in Undifferentiated Nasopharyngeal Carcinoma

Radiation-induced osteosarcomas (RIOS) after nasopharyngeal carcinomas are rare complication of radiotherapy and are associated with poor prognosis. Few cases are reported in the literature. Case report: We report a case of radiation-induced osteosarcoma involving the proximal humerus in a patient treated with radiotherapy for nasopharyngeal carcinoma (NPC) nine years ago. Surgical treatment could not be performed, and the patient received induction chemotherapy. He died from disease spread after three cycles. Conclusion: RIOS after treatment of NPC is very aggressive complication. Only a regular follow up of treated patient allow early detection of these tumors and best chances of survival.

CT and MRI of radiation-induced osteosarcoma of the mandibular ramus following radiotherapy for nasopharyngeal carcinoma: A rare entity

Radiotherapy is the main treatment modality for nasopharyngeal carcinoma. However, ionizing radiation is itself a known carcinogen, and sarcomas can be a complication of treatment. Radiation-induced osteosarcomas in the head and neck are particular rare. Imaging studies of radiation-induced sarcomas in patients with head and neck carcinoma have been limited to case reports and relatively small case series. We report an unusual case of a radiation-induced osteosarcoma of the mandibular ramus following radiotherapy for nasopharyngeal carcinoma with computed tomography (CT) and magnetic resonance imaging (MRI). These findings can be helpful for differentiating osteosarcoma from other tumors of the mandible.

Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma.

BackgroundThe increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible (RIOSM) has become a significant problem that can limit long-term survival. The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma (NPC).MethodsWe reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012. Of these patients, 47 who developed RISOM and met inclusion criteria were included in this study. Two of these 47 patients refused treatment and were then excluded.ResultsFor all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period, the total incidence of RIOSM after radiotherapy was 0.084% (47/53,760). Two patients (4.4%) had metastases at the diagnosis of RIOSM. Thirty-nine of the 45 (86.7%) patients underwent surgery for RIOSM; most patients (24/39; 61.5%) who underwent resection had gross clear margins, with 15 patients (38.5%) having either a gross or microscopic positive margin. All patients died. The 1-, 2-, and 3-year overall survival (OS) rates for the entire cohort of 45 patients were 53.3%, 35.6% and 13.5%, respectively. The independent prognostic factors associated with high OS rate were tumor size and treatment type.ConclusionsRISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention. Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.

Radiation-Induced Osteosarcoma Might Mimic Metastatic Bone Lesions

We report on a 53-year-old woman with osteosarcoma of the skull who underwent radiation therapy for metastatic brain tumor. She had a history of uterine endometrial cancer treated with chemotherapy and surgery 9 years previously. FDG PET/CT for surveillance showed nodular accumulation at the right suprainguinal region and very avid accumulation at the left side of the occipital bone. Bone scan showed increased accumulation at the same portion of the occipital bone. The occipital tumor was surgically removed and diagnosed as radiation-induced osteosarcoma.

A Case of Radiation-Induced Osteosarcoma after the Treatment of Pineoblastoma.

Radiation therapy has an important role in postoperative treatment of neoplasms originated from central nervous system, but may induce secondary malignancies like as sarcomas, gliomas, and meningiomas. The prognosis of radiation-induced osteosarcomas is known as poor, because they has aggressive nature invasive locally and intractable to multiple treatment strategies like as surgical resection, chemotherapy, and so on. We report a case of radiation-induced osteosarcoma developed from skull after 7 years of craniospinal radiotherapy for pineoblastoma.

The radiation-induced jaw osteosarcoma: CT imaging features

To evaluate the CT features of radiation-induced jaw osteosarcoma(RIJOS) developed after therapeutic irradiation for a variety of nonosseous lesions. The demographic and CT findings of thirteen patients with RIJOS were reviewed retrospectively.Observation items included location, bone destruction, mineralized tumor matrix, periosteal reaction, soft tissue extension and calcification.Of the thirteen patients, twelve were male and one was female. The mean age was 48 years (range: 29-68 years).Five patients had tumors in the maxilla and eight in the mandible. All the patients underwent tumor resection. The latent period before development of RIJOS ranged from 3.5 to 14 years (mean, 11 years).In all thirteen patients, eight tumors were osteoblastic, with one osteolytic and four mixed lesions.Osteoid tumor matrix mineralization was present in twelve patients. Periosteal reaction was identified in 11 cases.Soft-tissue extension was present in all patients beyond the area of bone destruction. The characteristic CT imaging of RIJOS showed the bone destruction associated with a large number of mineralized tumor matrix and significant soft tissue extension in the original radiation field after radiotherapy. CT findings could play an important role in identifying the tumor and pre-operative assessment.