School of Medicine; Division of Orthopedic Oncology, UMass Memorial Health Care; Department of Orthopedics and Physical Rehabilitation
Diagnosis | Health Services Administration | Neoplasms | Orthopedics | Radiation Medicine | Rehabilitation and Therapy | Telemedicine
Case Diagnosis: Post-irradiation Sarcoma
Case Description: A 58-year-old woman with a history of stage IIIB squamous cell carcinoma of the cervix who was treated with chemoradiation, considered in remission 5 years prior on PET CT, and was under every 6-months surveillance for recurrence by gynecology. She presented to the Emergency Department for severe back pain, left sided sciatica, and paresthesias. In the absence of fracture or cord compression, she was discharged with recommendations for primary care follow-up. This took place over the telephone with referral to the spine center. One week later, her pain progressed to 10+/10 with dense left leg numbness, and multiple falls. Physiatry ordered a lumbar MRI for focal neurologic findings on exam, which revealed a large destructive lesion of the left ilium and left hemisacrum with soft tissue extension. This was later determined to be undifferentiated sarcoma, likely due to prior radiation. She is currently undergoing palliative chemotherapy.
Discussions: Post-irradiation sarcomas (PIS) are a relatively rare event and exhibit dose dependency. Sarcomas can present with bone pain that can be worse at night and signs and symptoms of compression of surrounding structures. The pelvis is a common site for sarcoma development. Cases of PIS have presented in even just a few months post radiation therapy. The prognosis of patients with PIS is poorer than those with primary sarcomas. This patient would require hemipelvectomy to attempt curative treatment.
Conclusions: PIS are typically aggressive, have poor prognosis, and can develop within months of high doses of radiation therapies; clinicians index of suspicion for sarcomas in patients with a history of radiation must be high. Evaluation for progressive pain, weakness, and numbness may not be amenable to telemedicine until technology improves. Patients that present with signs and symptoms of progressive nerve compression and bone pain should be re-examined early on.
radiation therapy, post-irradiation sarcomas, diagnosis, case report
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DOI of Published Version
14th ISPRM (International Society of Physical and Rehabilitation Medicine) World Congress 2020
Jarnagin J, Baima J, Most MJ, Mazin DA. (2020). Don’t call me in the morning: why it might be best to see patients in-person, a case report. Orthopedics and Physical Rehabilitation Publications. https://doi.org/10.13028/gsy0-8p45. Retrieved from https://escholarship.umassmed.edu/ortho_pp/212