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We report three cases of atypical decubital fibroplasia (ADF), a benign, reactive pathologic process that develops in the skin and subcutaneous tissue of immobilized or debilitated patients. Two patients were immobilized, one wheelchair bound, and one bedridden. The third patient frequently lay over the affected area. Two were male, one female, ages 49, 66, and 89 (mean 68 years old). Each patient presented with a subcutaneous mass, one with focal surface ulceration, present for 5 months, 6 months, and 12 months (mean 7.7 months). The locations included back, lateral thigh (over greater trochanter), and lateral chest wall. No other lesions were present, and none had recurrences. Histologically, atypical decubital fibroplasia is characterized principally by dermal and subcutaneous tissue involvement with fibrinoid necrosis, reactive fibrosis, and focal myxoid change with surrounding more cellular zones of prominent reactive neovascularization including granulation tissue and ectatic vessels with reactive atypical fibroblasts and fat necrosis. Other findings include hyalinization of vessel walls, fibrin thrombi, red blood cell extravasation, hemosiderin deposition, and acute and chronic inflammation. Although the changes are predominantly deep, involving the dermis, subcutaneous tissue and skeletal muscle, the overlying epidermis may ulcerate. Recognition of atypical decubital fibroplasia is of paramount importance, for it may be misinterpreted as a sarcoma, both clinically and histologically.

Hemangiomatosis with osteolysis, osteosclerosis and loss of bony definition is an uncommon disease entity. Many forms of treatment have been used, varying almost from case to case. The use of radiation therapy has proved successful in the control of the disease process in reported cases. The current case of hind foot hemangiomatosis went on to develop sarcoma 17 years later in the uninvolved tibia at the margin of the radiation field, which proved to be fatal to the patient. Treatment by radiotherapy had permitted normal function for 15 years. This case highlights the difficulties of management of skeletal angiomatosis based on anatomic location and emphasizes the need for judicious planning and selection of the mode of delivery of radiotherapy.

Despite its anatomical location between two regions of high cancer risk, the small bowel rarely develops a malignant tumor. However, in recent years, small bowel cancer incidence rates have begun to rise. The purpose of this review is to explore the descriptive and analytic epidemiology of small bowel cancer for those factors that protect this organ and those factors associated with loss of this protection. Within the small intestine, the sites at the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas. In industrialized countries, small bowel cancers are predominantly adenocarcinomas; in developing countries, lymphomas are much more common. The incidence of small bowel cancer rises with age and has generally been higher among males than among females. The risk factors for small bowel cancer include dietary factors similar to those implicated in large bowel cancer, cigarette smoking, alcohol intake, and other medical conditions, including Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis. The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens. Adenocarcinomas of the small and large bowel are similar in risk factors and geographic distribution but not in recent time trends; colorectal cancer incidence rates in the United States have been falling since the mid-1980s. Small bowel lymphoma may be associated with infectious agents, such as HIV. Given the differences in anatomic and geographic location among histological subtypes, much may be learned from well-designed, histology-specific epidemiological and genetic studies of cancer of the small bowel.

Of 229 consecutive patients receiving allogeneic blood or bone marrow stem cell transplants for acute myeloid leukemia, chronic myeloid leukemia, or myelodysplastic syndrome between 1974 and 1996, 52 patients relapsed. The original tumor recurred as granulocytic sarcoma (chloroma) in three patients (1.3%). Chloroma was found in the ovary in two patients and in the central nervous system in one patient. None of these three patients had experienced > or = grade II acute or more than limited chronic graft-versus-host disease. The intervals between transplantation and recurrence with chloroma were 2, 6, and 13 years. Two patients received a second transplant, and all three died of treatment sequelae.

Context: There is a substantial risk of a second cancer for persons with hereditary retinoblastoma, which is enhanced by radiotherapy., Objective: To examine long-term risk of new primary cancers in survivors of childhood retinoblastoma and quantify the role of radiotherapy in sarcoma development., Design: Cohort incidence study of patients with retinoblastoma followed for a median of 20 years, and nested case-control study of a radiation dose-response relationship for bone and soft tissue sarcomas., Setting/participants: A total of 1604 patients with retinoblastoma who survived at least 1 year after diagnosis, identified from hospital records in Massachusetts and New York during 1914 to 1984., Results: Incidence of subsequent cancers was statistically significantly elevated only in the 961 patients with hereditary retinoblastoma, in whom 190 cancers were diagnosed, vs 6.3 expected in the general population (relative risk [RR], 30 [95% confidence interval, 26-47]). Cumulative incidence (+/-SE) of a second cancer at 50 years after diagnosis was 51.0% (+/-6.2%) for hereditary retinoblastoma, and 5.0% (+/-3.0%) for nonhereditary retinoblastoma. All 114 sarcomas of diverse histologic types occurred in patients with hereditary retinoblastoma. For soft tissue sarcomas, the RRs showed a stepwise increase at all dose categories, and were statistically significant at 10 to 29.9 Gy and 30 to 59.9 Gy. A radiation risk for all sarcomas combined was evident at doses above 5 Gy, rising to 10.7-fold at doses of 60 Gy or greater (P<.05)., Conclusions: Genetic predisposition has a substantial impact on risk of subsequent cancers in retinoblastoma patients, which is further increased by radiation treatment. A radiation dose-response relationship is demonstrated for all sarcomas and, for the first time in humans, for soft tissue sarcomas. Retinoblastoma patients should be examined for new cancers and followed into later life to determine whether their extraordinary cancer risk extends to common cancers of adulthood.

A comparison of the risk coefficients for 239Pu- or 226Ra-induced bone cancer in two canine breeds, one with a relatively low (beagle) and the other with a very high (St. Bernard) natural incidence, indicated only slightly higher risk in the giant breed. The differences in risk for skeletal malignancy in 239Pu and 226Ra dogs were nonsignificant (p > 0.05). Likewise, the values of the 239Pu:226Ra "toxicity ratios" for these respective breeds, using bone cancer as the endpoint, were not significantly different at the 0.05 level. The anatomical distribution of the radiation-induced bone tumors tended to be a function of both the bone mass and the skeletal distribution of the radionuclide, not the site of predilection for naturally occurring bone neoplasia. Although the etiology of the higher natural incidence of bone cancer in the St. Bernard was not determined, several possible factors, including a higher osteoblastic activity level in the St. Bernards, are presented. These data suggest that making extrapolations of radiation-induced bone cancer risk from animals to humans is valid.

Soft tissue sarcoma (STS) accounts for approximately 1% of all cancers diagnosed annually in the United States. Population-based data from Connecticut covering the years 1935-1989 have shown an increasing incidence of STS in both genders, with a greater increase among men than women. The recent increase in acquired immune deficiency syndrome-related Kaposi's sarcoma does not explain the upward trend in STS, dating back decades. Etiologic heterogeneity is suggested by epidemiologic variations that have been observed by subsite and cell type. Among the environmental factors associated with STS are external radiation therapy, Thorotrast, arsenical pesticides and medications, phenoxyherbicides, dioxin, vinyl chloride, immunosuppressive drugs, alkylating agents, androgen-anabolic steroids, human immunodeficiency virus, and human herpes virus type 8. In addition, STS occurs excessively among persons with certain heritable states including retinoblastoma, Li-Fraumeni syndrome, Gardner's syndrome, Werner's syndrome, nevoid basal cell carcinoma syndrome, neurofibromatosis type 1, and some immunodeficiency syndromes. These risk factors account for a minority of STS cases but provide leads for further epidemiologic and interdisciplinary studies into the genetic and environmental determinants of various forms of STS.

The importance of a multidisciplinary group in the treatment of soft tissue sarcomas is well established. This approach has led to a major shift in treatment from a single-modality radical surgery to a more sophisticated approach with limb-sparing resections integrated with external irradiation, interstitial irradiation, or both. The increasing knowledge of both the molecular mechanisms of sarcoma development and the biological characteristics (tumor cell proliferation, hypoxia, necrosis, angio-genesis) will enable us to predict prognosis on a more individual basis and thus allow for more selective treatment strategies. Studies relating these molecular markers and biological characteristics to treatment results obtained with surgery, radiotherapy, and chemotherapy are eagerly awaited.

The mortality pattern of women who began employment as luminizers in the radium dial industry before 1930 was followed through 1990. Hazard models with time-dependent covariates were used on mortality data either organized by individual death times or grouped into cross-classified person-year tables. These models were used to quantify trends in mortality associated with either death from or diagnosis of bone sarcoma or head carcinoma. The accumulation of skeletal doses from 226Ra and 225Ra was an important predictor of the risk of death from bone sarcoma. Women exposed to 226Ra at ages associated with active bone growth were at greater risk of bone sarcoma than women receiving even larger exposures at an age when their skeletons would have been fully developed. Exposure to only 226Ra was found to be an important predictor of risk for carcinoma of the mastoid air cells and paranasal sinuses. For the cranial sites, where adult dimensions are attained early in life, an effect of age at exposure could not be detected.

In 1988, a 27-year-old male patient received an allogeneic BMT for leukemic relapse 8 months after ABMT for AML (M2) in first complete remission. Because of chronic GVHD of the liver CsA was administered until 1994. Nine months after discontinuation of CsA, locally advanced gastric granulocytic sarcoma (GS) was diagnosed without evidence of systemic relapse. The patient was treated with two courses of polychemotherapy (ICE, NOVIA). Granulocyte colony-stimulating factor (G-CSF)-mobilized donor buffy coat cells were reinfused after each chemotherapy cycle in an attempt to accelerate hematopoietic regeneration and to induce a graft-versus-leukemia (GVL) effect. Local irradiation and surgical resection of residual leukemic cells resulted in complete remission. Seventeen months from diagnosis of GS the patient relapsed again with multiple lesions and died of generalized bleeding during aplasia after a third course of polychemotherapy (ICE). In our patient donor peripheral blood stem cell support did not accelerate hematopoietic regeneration (time to neutrophil recovery > 0.5 x 10(9) g/l from the start of chemotherapy was 27 days after ICE and 36 days after NOVIA) and did not result in long-term disease-free survival.

In order to investigate whether gender and castration have an effect on the time to the development of sarcoids, a retrospective study in a population of donkeys was conducted using survival analysis techniques. Univariable Kaplan Meier product limit curves identified males as having significantly lower survival probability, or higher risk of developing sarcoids, than females (P < 0.01). Cox's proportional hazard model was used to assess the effect of age at entry to the population whilst simultaneously considering the effect of gender on the hazard of developing sarcoids. Age at entry and gender were both significantly associated with the hazard of sarcoid (P < 0.01). Animals younger at entry were at increased risk of being diagnosed with sarcoids and the hazard ratio for being male was 1.9. Although male animals castrated after entering the population had significantly poorer survival rates than those castrated prior to entry, this effect was not significant when age at entry to the population was fitted to the model, demonstrating that the castration procedure within the population per se was not a risk factor. Although there was a trend toward stallions being at increased risk when compared to geldings, the effect was not statistically significant, particularly when controlling for age. It was concluded that a multicentre study or meta-analysis will be necessary to resolve the issue of risk associated with castration.

The authors describe two cases of sarcomas of the skull following cranial irradiation in patients treated for other neoplasms, acute lymphatic leukemia, and astrocytoma, respectively. The patients (one man and one woman: mean age 24.5 years) developed sarcomas within the irradiated field after a mean latency period of 11.5 years. Histologically, the tumor proved to be a fibrosarcoma. Despite aggressive surgery and other therapy, the survival of the patients was short (10 and 8 months, respectively). The pathological and clinical aspects of this unusual complication are analyzed with reference to 41 cases taken from the world literature.

A soft tissue sarcoma occurred in the interscapular area of a cat, 1 to 7 months after vaccination at that site. The vaccine contained inactivated feline panleucopaenia virus combined with modified live feline herpesvirus and calicivirus. The tumour showed histological features of both fibrosarcoma and malignant fibrous histiocytoma. The tumour was observed to evolve from the site of a presumed postvaccinal granuloma. Local recurrence 6 weeks post excision necessitated more radical resection. Euthanasia was performed 2 years later when pleural effusion developed. The cause of effusion was not determined. There was no palpable evidence of local tumour regrowth at the time of euthanasia. A causal relationship between vaccination and sarcoma formation is considered based on the temporal association between the two events, the anatomical location of the tumour and histopathology consistent with postvaccinal sarcomas reported overseas. Six other vaccine site fibrosarcomas, potentially vaccine associated using the above criteria, are summarised.

Background: As a part of multimodality therapy, many patients with tumors of the trunk receive radiation therapy. The major morbidity of this therapy is often secondary to incidental radiation damage to tissues adjacent to treatment areas., Methods: We detail our use of saline breast implants placed in polyglycolic acid mesh sheets to displace visceral and solid organs away from the radiation field., Results: Analysis of CT scans and dose volume histograms reveal that this technique successfully displaces uninvolved organs away from the radiation fields, thereby minimizing the radiation dose to such organs and tissues., Conclusion: We believe this is a safe and efficacious method to prevent radiation damage to visceral and solid organs adjacent to trunk tumor sites.

The development of a cancerous tumour at the site of total joint replacement is a rare but virtually always fatal event. The previously unreported scenario of a patient who was found to have a malignant fibrous histocytoma at the bone-cement membrane after revision for a loose total hip prosthesis is reported. Recent biologic information evaluating the response of mesenchymal cells to metallic debris suggests that the environment surrounding a loosened prosthesis may provide conditions appropriate for the development of a sarcoma.

Objective: To obtain an estimate of the yearly prevalence of injection-site sarcomas in cats., Design: Mail survey of members of the American Association of Feline Practitioners., Procedure: A questionnaire was sent to 1,112 veterinarians., Results: 235 responses were sufficiently complete for inclusion in the study. Overall, responding veterinarians reported 744,993 cat visits in 1992, representing 434,638 individual cats (1.7 visits/cat). The estimated overall prevalence of injection-site sarcomas during 1992 was 0.00021 cases/cat visit (2.1 cases/10,000 cat visits) or 0.00036 cases/cat (3.6 cases/10,000 cats)., Clinical Implications: Results suggest that injection-site sarcomas were rare during 1992.

Background: Malignant transformation to endometriosis is a well documented phenomenon that occurs most commonly in the ovaries with cancer arising in extra-ovarian endometriosis being a rare event., Methods: A retrospective clinical-pathological evaluation of eleven cases with malignant tumors arising in endometriosis was performed to evaluate the prognostic impact of various factors. Nuclear DNA content (ploidy) was assessed through flow cytometric study., Results: Ovarian origin was identified in eight cases and three were associated with extra-ovarian endometriosis. Histologic type was endometrioid carcinoma in ten patients. The eleventh case had high grade endometrial stromal sarcoma. All tumors were diploid with no relation to stage, grade, or clinical outcome. The S-phase fraction (SPF) was analyzed in nine patients and no correlation could be demonstrated with any histologic parameters or clinical outcome., Conclusions: The DNA content seems to have no association with the classical prognostic parameters in these cases.

Soft tissue sarcomas are relatively rare tumors with an annual incidence of 5000 to 6000 in the United States. The primary therapy is surgical resection with an adequate margin of normal tissue. For patients at high risk local control is improved with postoperative adjuvant radiation. Local recurrence rates vary depending on the anatomic site. In extremity lesions one third of patients will have locally recurrent disease with a median disease-free interval of 18 months. Treatment results for extremity local recurrence may approach those for primary disease. Isolated pulmonary metastases may be resected with 20% to 30% 3-year survival rates. Patients with sarcomas in other sites present similar but more difficult problems in terms of local control and management of disseminated disease. Patients with unresectable pulmonary metastases or extrapulmonary metastatic sarcoma have a uniformly poor prognosis and are best treated with systemic chemotherapy.

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 was 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.

A small but growing number of radiation-induced sarcomas after breast-conserving surgery for carcinoma have been reported. Because breast-conserving surgery followed by irradiation is becoming increasingly popular, the potential for the emergence of these sarcomas is growing. Unfortunately, because of postirradiation changes in the affected breast, detection of a new lesion can be difficult, resulting in a delay in diagnosis. This case history describes a 48-year-old woman in whom a malignant fibrous histiocytoma was discovered 5 years after she had had a lumpectomy followed by radiation therapy for infiltrating ductal carcinoma. Although the exact mechanism of radiation-induced carcinogenesis is unclear, one theory is discussed. Also discussed are the histologic composition of the malignant fibrous histiocytoma, its latency period, and the best treatment modality for radiation-induced sarcomas.

Aims and Background: Post-irradiation sarcoma (PIS) a rare, late side effect of radiotherapy and, consequently, its natural history is not well known. For this reason, two cases treated between 1975 and 1990 are described., Case Reports: The Authors describe one case of malignant fibrous histiocytoma grown in the larynx 111 months after conservative surgery and postoperative radiotherapy, and one case of soft tissue sarcoma developed in the oral cavity 72 months after radical interstitial low dose rate brachytherapy. Both patients had chronic distress of the soft tissues after the primary treatment. The patients are alive and well respectively at 94 and 18 months from salvage surgery., Discussion: The PIS of the head and neck region is a rare event, usually with a bad prognosis. An improvement in results could be possible with early diagnosis, followed by a timely excision, when anatomically possible. As the chronic suffering of the irradiated tissues may increase the risk of PIS, a longer and more frequent follow-up is advisable in these cases.

Recent information regarding vaccine site-associated sarcomas in cats suggest a relationship to either feline leukemia virus or rabies vaccines. The authors' initial case was in a cat that had received neither of these vaccines. Review of the available hospital records revealed an increasing number of vaccine site-associated sarcomas, none of which were related to feline leukemia virus vaccines. Only one was related to the use of a rabies vaccine, and this tumor occurred in the thigh as opposed to between the shoulder blades. The laboratory data supported an increasing incidence of vaccine site-associated sarcomas, the majority of which occurred in the interscapular area and were associated with routine prophylactic vaccinations.

Sarcomas of the head and neck are rare. They present a challenge to the head and neck oncologist that is frequently quite different from that found in epithelial, salivary, and endocrine malignancies of the head and neck. The focus of this article is on diagnostic criteria, prognostic indicators, and therapy, and due to the large number of lesions, an in-depth review of the commonest: osteosarcoma (OS), chondrosarcoma (CS), rhabdomyosarcoma (RMS), fibrosarcoma (FS), malignant fibrous histiocytoma (MFH), and synovial sarcoma (SS). Less common variants will also be mentioned. Twelve cases are presented, consisting of OS(2), RMS(1), CS(3), MFH(2), SS(2), FS(1), and miscellaneous(1). Conclusions consist of an enunciation of the general principles of management of sarcoma of the head and neck.

The causal agent for sarcomas is mostly unknown. Unlike solid epithelial carcinomas, the correlation to the exposition to carcinogenic agents is unknown. Besides hereditary neurofibromatosis ("Recklinghausen"), radiation therapy has been reported to induce malignant tumors. In this retrospective study during the last 10 years we observed that in 7 of 356 (approximately 2%) patients treated for sarcomas in our Department of Surgery, the sarcoma was located in the area where radiation therapy had been given earlier for another primary malignant tumor. The interval between this radiation therapy and the diagnosis of sarcoma was 9 to 30 years, corroborated by findings in the literature based on approximately 100 radiation-induced tumors. The median survival time after diagnosis of sarcoma was 3 years. Because radiation therapy is often used in the treatment of malignant tumors this late complication is a clinically relevant problem in long-time survival.

Epidemiologic evidence shows a strong association between the administration of inactivated feline vaccines (feline leukemia virus and rabies) and subsequent soft tissue sarcoma development at vaccine sites. Although more research is needed to understand the complete pathogenesis of vaccine-induced tumors in cats, good evidence exists that inflammation plays a role.

In a review of 8724 de novo malignancies that occurred in 8191 organ allograft recipients sarcomas were 7.4% of cancers. Kaposi's sarcoma (KS) made up 5.7%, and other sarcomas (OS) 1.7% a much higher proportion than in the general population. KS was most common in Arab, black, Italian, Jewish, or Greek patients. In 60% of patients with KS the lesions were confined to the skin and/or oropharynx while 40% involved internal organs and/or lymph nodes. Complete remissions following various treatments occurred in 53% of the former group and 27% of the latter. In both groups 32% and 60% of remissions, respectively, occurred when the only treatment was reduction or cessation of immunosuppressive therapy. However, this treatment caused impaired function or allograft loss from rejection in 22 of 34 kidney recipients. Recurrent KS occurred in 5% of patients in remission when immunosuppressive therapy was resumed. Nine of 114 patients (8%) tested for human immunodeficiency virus were positive. Most OS arose in internal organs or soft tissues. The major types were fibrous histiocytoma (20 patients), leiomyosarcoma (15), fibrosarcoma (12), rhabdomyosarcoma (9), hemangiosarcoma (8), undifferentiated sarcoma (7) and mesothelioma (6). Several unusual features were noted. Remarkably, 10 of 105 (10%) sarcomas occurred adjacent to or in a renal (6) or hepatic (4) allograft. Leiomyosarcomas are rare in children, yet 5 of 15 (33%) occurred in pediatric patients. Three hemangiosarcomas occurred in forearms at sites of arteriovenous fistulas used for pretransplant hemodialysis access. One leiomyosarcoma and one fibrosarcoma occurred in previously irradiated areas. One patient with mesothelioma had a history of asbestos exposure and two others had possible exposure.

The development of sarcoma subsequent to cranial irradiation is a rare but serious and potentially fatal event. We describe seven patients who had undergone cranial irradiation (range, 1600-6000 cGy) to treat their primary disease and who developed sarcomas within the irradiated field. The median time from radiation therapy to the development of a sarcoma was 8 years (range, 4 to 15 yr). Fibrosarcomas developed in four patients, and malignant fibrous histiocytomas developed in three. Despite aggressive treatment, the prognosis was poor; the median survival from the diagnosis of sarcoma was 19 months. Sarcoma should be considered in the differential diagnosis of a new lesion or a lesion that progresses several years after radiation therapy.

The carcinogenic potential of artificial implants has been of concern in recent years. Case reports and animal studies, dating back to the 1950s, have reported possible associations between artificial implants and soft tissue sarcomas, but epidemiologic data have been lacking. In a recent study of soft tissue sarcomas and military service, data on artificial implants were collected but not presented. This paper examines a possible association between artificial implants and soft tissue sarcomas.

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly, in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.

Soft tissue sarcomas in the head and neck are rare. Aetiological factors relating to these tumours have not yet been identified. The association with von Recklinghausen's disease and with irradiation is however well recognized. In the literature it has been speculated that trauma may also play a role in the development of soft tissue sarcomas. In this article we present five patients with a history of surgical trauma at the site where a sarcoma later developed. Although we cannot prove a causal relationship, the relatively high incidence of possibly trauma-related soft tissue sarcomas in a series of 60 patients we have seen over a 30-year period, suggests that such a relationship could exist.

Purpose: First to describe clinical and pathologic features of sarcomas arising after radiation therapy for breast cancer and to report three cases of sarcoma arising 7, 15, and 20 years following radiation therapy for breast cancer. Second, to review the literature on this treatment complication., Methods and Materials: Medline literature search., Results: The most frequent histology is osteosarcoma and bone is affected more commonly than soft tissue at a median latency of 11 years. The scapula is the most frequently affected bone. The most frequently affected soft tissue site is now the conserved breast with a median latency of 5.5 years. The aetiologic factors relating to these sarcomas are not fully defined with factors of beam energy, radiation dose, chemotherapy and regional edema being inconsistently reported., Conclusion: The frequency of radiation-induced sarcoma at 10 years of follow-up is approximately 0.2%. This is an overestimate by an unknown factor because of the description of sarcomas arising metachromously in breast cancer patients, in nonirradiated areas.