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Osteogenic Sarcoma Following Radiotherapy for Retinoblastoma

1969; Radiological Society of North America; Volume: 93; Issue: 5 Linguagem: Inglês

10.1148/93.5.1185

1527-1315

Tatsuo Yoneyama, Robert H. Greenlaw,

Nonmelanoma Skin Cancer Studies

The Rarity of osteogenic sarcoma following radiotherapy for retinoblastoma is attested by Solway (1966), who was able to collect only 9 cases including 3 of his own. Because of its rarity and the lack of information on the mechanism by which bone sarcoma is induced following the radiotherapy, the following case is reported. Case History In October 1948, this 6 1/2-month-old Caucasian boy was found to have retinoblastoma of the right eye. One-half month after enucleation in a local hospital, examination of the left eye showed three areas of retinoblastoma. Between Dec. 6, 1948, and Feb. 23, 1949, irradiation was given by means of a lateral temporal portal (2.5 cm in diameter) and a medial portal (2 cm in diameter) on the right side of the nose aimed obliquely toward the posterior aspect of the left eye. Factors involved with the treatment included 220 kV x ray filtered by 0.5 mm Cu and 1.0 mm AI. The machine was operated at 20 mA, and a target-skin distance of 50 cm was used. The portals were treated alternately. The dose calculated in air for each treatment was 400 R, and the total dose estimated in air at the entry of each treatment port was 6,800 R. If we estimate a depth of 1.5 cm from surface to the middle of the cross-fire volume, the maximum aggregate dose to soft tissue was 10,700 rad and to the bone in this zone, 32,260 rad. When the child was two years and three months of age, a secondary glaucoma was found in the left eye, and a partial iridectomy was performed. The glaucoma was not relieved, so that six weeks later that eye was enucleated. Unfortunately, pathologic data on the operative specimen are not available. The patient's history was unremarkable for the following fifteen years. A plastic prosthesis was used, and it was known that the facial bones about the orbits were hypoplastic. In addition, skin atrophy, telangiectasia, and irregular pigmentation in the region of the two treatment ports were present at the left orbital rim laterally and the inner canthus of the right eye. At the age of seventeen, the boy noted swelling behind the prosthesis in the left eye associated with retro-orbital headaches as well as numbness of the left nasolabial fold. Examination disclosed an exuberance of soft tissue behind the prosthesis. A roentgenogram showed clouding of the left maxillary antrum, but no bone destruction was noted. A somewhat abnormal electroencephalogram was thought compatible with tumor invasion of the anterior fossa on the left side. Biopsies of the lesion, taken on two occasions with a skin drill, revealed only chronic inflammation. Pathologic study of a third open biopsy was reported as a cellular osteogenic sarcoma. Further radiographic studies could not confirm extension beyond the orbit or maxillary antrum. A: 3-view brain scan, using 1 millicurie of 197Hg chlormerodrin (Squibb), was regarded as normal. Spinal fluid pressure was normal while protein was 67 mg per 100 ml.