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Induction or Predisposition?

Matthew B. Schwarz, MD; Lawrence P. A. Burgess, MD, MAS, MC; Willard E. Fee, Jr, MD; Sarah S. Donaldson, MD

Arch Otolaryngol Head Neck Surg. 1988;114(6):640-644.

Abstract
• An alarmingly high rate of postirradiation sarcomas following treatment for retinoblastoma has been described in the literature. We present four new cases and report 57 others from the English literature. Osteogenic sarcoma was the predominant histologic type (58%), followed by fibrosarcoma (21%) and various other sarcomas (21%). The average latency period between irradiation and development of the second primary (sarcoma) was 12.4 years. Irrespective of irradiation, a genetic linkage between retinoblastoma and osteogenic sarcoma on the 13q14 chromosome is recognized. Through a pleiotropic effect of this same chromosome, a predisposition for other sarcomas may exist as well. Finally, a strong role for radiation induction is proposed for all of these postirradiation sarcomas. This is based on the increased number of sarcomas arising in the field of prior irradiation (sites uncharacteristic of spontaneously occurring primary sarcomas) and the prolonged latency periods.

(Arch Otolaryngol Head Neck Surg 1988;114:640-644)

Author Affiliations
From the Division of Otolaryngology, Departments of Surgery (Drs Schwarz, Burgess, and Fee) and Therapeutic Radiation (Dr Donaldson), Stanford (Calif) University Medical Center.

Footnotes
Accepted for publication Jan 11, 1988.

Read in part before the 28th annual meeting of the American Society for Head and Neck Surgery, Palm Beach, Fla, May 8, 1986.

The opinions or assertions contained herein are the private views of the authors and should not be considered as official or as reflecting the views of the Department of the Army or Department of Defense.

Reprint requests to Division of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, Edwards Bldg, Room 135, Stanford, CA 94305 (Dr Fee).

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