![]() Nevertheless, because radiation-related sarcoma is a very rare event, studies have generally been small, and many questions remain about the relationship. In the last few decades much has been learned about the relationship by studying the occurrence of sarcomas after radiotherapy treatment for both benign and malignant diseases. Martland’s famous report of bone sarcomas in the jaws of radium-dial painters followed in 1929. The first case reports of bone sarcomas in patients who had received radiotherapy for benign bone conditions were published as early as 1922, making it one of the first solid cancers to be linked to radiation. Sarcomas are a rare but highly fatal outcome of radiation exposure. Efforts to limit unnecessary high-dose radiation exposure, particularly in children, therefore remain important given the high fatality rates associated with this disease. Similar to many other cancers children have the highest risks of developing a radiation-related sarcoma. In summary, radiation exposure remains one of the few established risk factors for both bone and soft tissue sarcomas. ![]() Some evidence suggests that it may be possible to identify radiation-induced sarcomas by a distinct molecular signature, but this work needs to be replicated in several dose settings, and the potential role of chemotherapy and tumor heterogeneity needs to be examined in more detail. The effects of common low-penetrance alleles on radiosensitivity in the general population have not been well-characterized. While there is evidence that individuals with certain rare familial genetic syndromes predisposing to sarcoma, particularly Nijmegen Breakage Syndrome, are particularly sensitive to the effects of high dose radiation, it is unclear whether this is also true in very low-dose settings (<0.1 Gy). New findings from the long-term follow-up of the Japanese atomic bomb survivors suggest, for the first time, that sarcomas can be induced by acute lower-doses of radiation (<5 Gy) at any age, and the magnitude of the risk is similar to that observed for other solid cancers. ![]() ![]() There are few studies available of sarcoma after radiotherapy in adulthood for cancer, but data from cancer registries and studies of treatment for benign conditions confirm that the risk of sarcoma is also increased in this age-group after fractionated high-dose exposure. There is clear evidence of an increased risk of both bone and soft tissue sarcomas after high-dose fractionated radiation exposure (10 + Gy) in childhood, and the risk increases approximately linearly in dose, at least up to 40 Gy. We reviewed the current evidence on this relationship, focusing particularly on the studies that had individual estimates of radiation doses. Sarcomas were one of the first solid cancers to be linked to ionizing radiation exposure. ![]()
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