Radiation-induced osteosarcoma in the head and neck region: Case report and literature review

Radiation-induced sarcoma (RIS) is a rare but highly aggressive complication of radiotherapy, especially in the head and neck region (RIS-HN). This report describes a case of radiation-induced osteosarcoma (RIOS) in a 32-year-old woman with a history of craniopharyngioma treated with surgery and radiotherapy 13 years prior. The patient exhibited symptoms including epistaxis, diplopia, and ptosis of the right eyelid. Imaging revealed a large, inoperable tumor in the area that had received prior radiotherapy. A biopsy confirmed the diagnosis of osteosarcoma, and the patient initiated palliative chemotherapy. Unfortunately, the treatment was unsuccessful, and the patient passed away. A review of 148 RIOS cases published in the last 25 years in the literature shows that the maxilla and mandible are the most affected sites (68.86 %), with an average latency of 11.79 years. The most common primary tumor was nasopharyngeal carcinoma, treated with an average radiation dose of 61.69 Gy. The prognosis remains poor, with 72.3 % of patients dying within an average of 23 months of follow-up. This study highlights the clinical and pathological characteristics of RIOS, the importance of long-term monitoring of irradiated patients to detect and treat these tumors early, with the aim of improving patient outcomes.