Radiation-associated malignant tumors of the chest wall

Background: Malignant postirradiation cancers of the chest wall are uncommon, and data concerning results of treatment are sparse. We assessed patient characteristics as well as prognostic factors of these tumors compared with those arising de novo and analyzed treatment results of both groups. Methods: Records of 361 patients with primary malignant tumors of the chest wall admitted to our institution between 1949 and 1989 were reviewed retrospectively. Previous radiotherapy to the site of the tumor was noted with latency period and dose. Survival was calculated via the Kaplan-Meier method, and comparisons of survival were made by log-rank analysis. Results: In 351 patients with primary malignant tumors of the chest wall, 21 lesions (6%) arose in an irradiated field. Eighty-eight patients had chondrosarcoma (age range 5-86 years, median 49; male:female [M:F] ratio 1.3:1), two cases of which arose in an irradiated field; 38 patients had osteosarcoma (age range 11-78 years, median 42; M:F ratio 1.5:1), 11 cases (29%) of which arose in an irradiated field; 149 patients had soft-tissue sarcoma (age range 1-86 years, median 38; M:F ratio 2:1) seven cases (5%) of which arose in an irradiated field; 52 patients had Ewing's sarcoma (age range 2-39 years, median 16; M:F ratio 1.6:1) no cases of which arose in an irradiated field; and 24 patients had a solitary plasmacytoma (age range 37-75 years, median 59; M:F ratio 2.4:1) one case (5%) of which arose in an irradiated field. Prior radiotherapy had been performed for Hodgkin's disease (n = 8), breast cancer (n = 5), and various other indications (n = 8). The maximum radiation dose administered ranged from 1,250 to 9,500 cGy (median 4,140). The latency period from previous irradiation to diagnosis ranged from 2 to 19 years (median 7). The primary therapy of all radiation-associated tumors was resection, except for three patients. There was no significant difference in survival between those malignant chest wall tumors arising in an irradiated field compared with those arising de novo. Conclusions: Twenty-nine percent of patients with primary osteosarcoma and 2-5% of patients with primary chondrosarcoma, soft-tissue sarcoma, or plasmacytoma of the chest wall seen at this institution have a tumor arising in the field of prior irradiation. Because the outcome after operative therapy appears to be similar, these patients should be offered identical treatment to those whose tumors arise de novo.