Radiation-induced soft tissue sarcoma of the neck after radiation therapy for Hodgkin's lymphoma: a clinical case

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Background. Radiation-induced malignancies are one of the long-term complications of radiation therapy, which is widely used to treat some tumors. The latency period before a second tumor develops varies from 3 to 60 years. Epithelial tumors and hemoblastoses occur after low-dose radiation therapy and sarcomas after high-dose radiation therapy.

Aim. To present a case of radiation-induced soft tissue angiosarcoma of the neck after the cure of Hodgkin's disease.

Materials and methods. A 41-year-old patient with Hodgkin's nodular lymphoma with the lymphoid predominance of stage IIIA with involvement of the right cervical and clavicular lymph nodes, mediastinum, and abdominal lymph nodes was followed-up. In 2004 the patient underwent four cycles of polychemotherapy per ABVD regimen followed by radiotherapy of the right cervical and clavicular lymph nodes and mediastinum, with a total focal dose of 40 Gy.

Results. Seventeen years after the treatment for Hodgkin's disease, including radiation therapy, the patient presented with painful swelling of the neck soft tissues in the radiation area with the transition to the anterior thoracic wall and an enlarged cervical lymph node. A lymph node dissection was performed. According to the combined positron emission tomography and X-ray computed tomography (PET/CT), histological and immunohistochemical studies, epithelioid angiosarcoma of soft tissues of the neck and thoracic wall stage IV cT2N1M1G3 with metastases to the skeleton bones, neck lymph nodes, left adrenal gland was established. Surgical treatment was not performed due to advanced disease. The patient received six cycles of polychemotherapy with doxorubicin + ifosfamide. PET/CT confirmed partial tumor regression.

Conclusion. Radiation-induced soft tissue sarcoma is a late iatrogenic complication of radiation therapy for Hodgkin's lymphoma. The tumor occurred in the radiation area. PET/CT is the method of choice in diagnosing and evaluating the extent of cancer and response to treatment. Chemotherapy, as an option for complex treatment, can achieve adequate disease control when surgery is not feasible.

作者简介

Nikolai Ognerubov

Derzhavin Tambov State University; Tambov Regional Oncological Clinical Dispensary

编辑信件的主要联系方式.
Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247
SPIN 代码: 3576-3592

D. Sci. (Med.), Cand. Sci. (Law), Prof.

俄罗斯联邦, Tambov; Tambov

Tatiana Antipova

PET-Technology

Email: antipovats@gmail.com
ORCID iD: 0000-0003-4165-8397

doctor

俄罗斯联邦, Tambov

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2. Fig. 1. Female patient B., 41 years old. PET/CT with 18F-FDG before the treatment. MIP PET, sagittal and coronal CT, and PET/CT projections show solitary cervical lymph nodes of group IIA/B on the right, with a radiopharmaceutical uptake with SUVmax of 2.90, and multiple supraclavicular lymph nodes on the right with metabolic size of 16×29 mm, SUVmax – 7.90.

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3. Fig. 2. Female patient B., 41 years old. PET/CT with 18F-FDG before the treatment. Axial CT and PET/CT views reveal a mass of the left adrenal gland medial limb of 16×13 mm with a radiopharmaceutical uptake with SUVmax of 8.78.

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4. Fig. 3. Female patient B., 41 years old. PET/CT with 18F-FDG at the end of 6 cycles of polychemotherapy. The neck lymph nodes were not enlarged on MIP PET, sagittal and coronal CT, and PET/CT views; no increased metabolic activity was observed. Abnormal tissue at the thyroid gland level was not found.

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5. Fig. 4. Female patient B., 41 years old. PET/CT with 18F-FDG at the end of 6 cycles of polychemotherapy. Axial CT and PET/CT views showed no mass in the area of the left adrenal gland medial limb; the mass regressed.

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