ELSZVIER (Ilinical \euroIog~ and Neurosurgery Clinical Neurology and Neurosurgery 96 (1994) 226 -229 Radiation-induced osteosarcomas of the skull: report of two cases and review of the literature Maurizio Salvati*, Luigi Cervoni, Pasquale Ciappetta, Antonino Race Department of Neurological Sciences, Neurosurgery, ‘La Sapienza’ University of Rome, l!le UniversitZr 301A, 00185 Rome. Italy Received 23 March 1993; revised 5 January 1994; accepted 23 February 1994 Abstract Osteosarcoma of the skull as a second neoplasm after radiation therapy is unusual. This neoplasm generally occurs after doses of over 10 Gy. CT, MRI and biopsy are the main diagnostic procedures for this lesion. We report two other cases of osteosarcornas of the skull and review the pertinent literature. Key words: Chemotherapy; Oncogenesis; Osteosarcoma; Skull; Radiotherapy 1. Introduction Ionizing radiation plays a key role in the treatment of neoplastic disease. It may, however, be followed by major side effects such as radionecrosis or a second tumor [l-44]. Osteosarcoma is a well-known, but rare, complication of radiotherapy for neoplastic disease that, as a rule, occurs after doses of ionizing radiation of over 10 Gy. We report two cases of post-radiation osteosarcoma of the skull seen at our Department, neither or whom had preexisting neuroflbromatosis or retinoblastoma. 2. Case reports zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Case 1 This was a 45-year-old man with a 4-month history of dragging frontal headache with diplopia in the last 20 days. He had received radiotherapy 12 years before (44 Gy to the region) following removal of hypophyseal ade- noma. On admission, neurological examination showed a left cranial nerve VI deficit. A CT scan showed a sphe- noid bone tumor localized in the area that had been *Corresponding author. irradiated 12 years earlier. A carotid angiogram showed a blush supplied by the internal maxillary artery. On surgery a large, highly vascularized, greyish-red mass was found which was removed subtotally. The his- tological diagnosis was fibroblastic osteosarcoma. After an uneventful postoperative course the patient was dis- charged on day 9. After radiotherapy (50 Gy) to the residual lesion, serial neuroradiological exams showed regression. After 13 months the patient’s symptoms reappeared. A craniocerebral CT scan show a lesion involving the entire middle cranial fossa. The relatives refused any further treatment and the patient died 3 months later. No autopsy was done. Case 2 This 44-year-old woman reported a 3-month history of bouts of dragging headache accompanied in the last 15 days by vomiting. She had had a course of orthovolt- age radiotherapy for a squamous cell carcinoma of the frontal region (45 Gy, no other details given) 16 years before. On neurological examination she was found to have intracranial hypertension with bilateral papille- dema. Alkaline phosphatase was 300 IU. A craniocere- bra1 CT scan revealed a large lesion of the frontal and parietal bones which, on angiography, was supplied by meningeal vessels. The tumor was localized in the area irradiated 12 years earlier. Macroscopically, total removal of a large brownish- 0303~8467/94/$7.00 0 1994 Elsevier Science B.V. All rights reserved SSDI 0303-8467(94)00012-U