Radiation-induced Sarcoma in the Head and Neck: Clinical, Imaging, Histopathological, and Therapeutic Characterization

Wilber Edison Bernaola-Paredes, DDS, OMS, MSc, PhD; Eloah Pascuotte Filippetti, MD; Monica Lucia Rodrigues, MD, MSc; Henrique Perez Carvalho, MD; Marcelo Carvalho Coutinho, MD; Arthur Ferrari Arruda, MD; Pedro Jorge Joffily Pinto, MD; Felipe D’Almeida Costa, MD, PhD; Miriã Andrade Celestino, MD; Antonio Cassio Assis Pellizzon, MD, PhD

doi:10.1097/GOX.0000000000004418

Plastic and Reconstructive Surgery, Global Open (Jul 2022)

Radiation-induced Sarcoma in the Head and Neck: Clinical, Imaging, Histopathological, and Therapeutic Characterization

Wilber Edison Bernaola-Paredes, DDS, OMS, MSc, PhD,
Eloah Pascuotte Filippetti, MD,
Monica Lucia Rodrigues, MD, MSc,
Henrique Perez Carvalho, MD,
Marcelo Carvalho Coutinho, MD,
Arthur Ferrari Arruda, MD,
Pedro Jorge Joffily Pinto, MD,
Felipe D’Almeida Costa, MD, PhD,
Miriã Andrade Celestino, MD,
Antonio Cassio Assis Pellizzon, MD, PhD

Affiliations

Wilber Edison Bernaola-Paredes, DDS, OMS, MSc, PhD: From the * Department of Radiation Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
Eloah Pascuotte Filippetti, MD: From the * Department of Radiation Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
Monica Lucia Rodrigues, MD, MSc: † Department of Head and Neck Surgery & Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
Henrique Perez Carvalho, MD: † Department of Head and Neck Surgery & Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
Marcelo Carvalho Coutinho, MD: † Department of Head and Neck Surgery & Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
Arthur Ferrari Arruda, MD: ‡ Department of Anatomic Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil
Pedro Jorge Joffily Pinto, MD: From the * Department of Radiation Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil
Felipe D’Almeida Costa, MD, PhD: ‡ Department of Anatomic Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil
Miriã Andrade Celestino, MD: § Department of Stomatology, School of Dentistry, University Center “UNIFAMINAS,” Muriaé, Minas Gerais, Brazil.
Antonio Cassio Assis Pellizzon, MD, PhD: From the * Department of Radiation Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil

DOI: https://doi.org/10.1097/GOX.0000000000004418
Journal volume & issue: Vol. 10, no. 7
p. e4418

Abstract

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Summary:. Radiation-induced head and neck sarcoma (RIHNS) is a rare and serious long-term complication of radiotherapy (RT), with poor prognosis and high morbidity and mortality. Diagnosis is based on immunohistochemistry and molecular biomarker analysis, and therapy is usually surgical. Other adjuvant therapies might be considered. This case report aimed to describe the clinical, imaging, histopathological, and therapeutic characteristics of a rare case of RIHNS in the mandible after 21 years of RT. A 68-year-old male patient underwent a partial left parotidectomy in 1995, was diagnosed with pleomorphic adenoma, and after recurrence of the lesion in 2000, underwent an ipsilateral total parotidectomy with adjuvant RT. In May 2021, he complained of an ulcerated nodular lesion on the tongue that extended toward the lower gingiva, associated with oral bleeding and difficulties with swallowing. After biopsy in the gingival margin and histopathological analysis, the diagnosis of high-grade spindle-cell sarcoma was established. Complete surgical resection with microsurgical reconstruction using a fibular osteomusculocutaneous free flap was performed. RIHNS could appear after a period of almost 20 years after RT. Surgical resection with reconstructive surgery was a reliable and feasible therapeutic option that showed favorable clinical results after an appropriate follow-up.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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