Nine patients who had an osteosarcoma that had developed as a second
malignant neoplasm in a previously irradiated site were managed at a major
center for the treatment of tumors in children. The doses of radiation had
averaged 4144 centigray (range, 2300 to 8000 centigray) and chemotherapy
had been administered, when appropriate, for the primary malignant lesion
(Ewing sarcoma, malignant fibrous histiocytoma, Hodgkin lymphoma,
neuroblastoma, neurofibrosarcoma, rhabdomyosarcoma, and Wilms tumor). The
interval between the initial treatment and the diagnosis of the secondary
sarcoma averaged ten years and one month (range, five years and ten months
to twenty-one years and nine months). Three patients were alive, two of
them with active disease, at the time of writing. The other six had died
within three years (average, fifteen months) after the second diagnosis.
The prevalence of secondary osteosarcoma is increasing as the survival of
children who have a malignant lesion increases. Plans for tumor therapy
should take into account the risk of this complication, which is usually
fatal.