Thoracic paravertebral osteosarcoma induced by radiotherapy for esophageal cancer: A case report

With the wide application of radiation therapy for malignant tumors and the continuous improvement of comprehensive treatment effect, the survival period of patients has been prolonged, while the incidence of radiation-induced osteosarcoma (RIOS) has gradually increased. Compared with primary osteosarcoma, RIOS has a higher degree of malignancy and poorer prognosis, severely impacting patient survival. Currently, there are relatively few case reports on RIOS and the understanding of its imaging characteristics remains incomplete. A patient with esophageal cancer who was found to have thoracic paravertebral masses six years after receiving radiotherapy was encountered at Zhuji People's Hospital (Zhuji, China). Computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT all indicated the presence of the malignant tumors. Subsequently, the patient was hospitalized for CT-guided puncture biopsy of thoracic paravertebral masses. Through multidisciplinary discussions in the departments of Medical Oncology, Orthopedics, Radiology and Pathology, a consensus was finally reached on RIOS. In conclusion, RIOS is a severe and relatively rare complication of radiotherapy with a poor prognosis. In its early stage, it is easily confused with bone changes after radiotherapy and appearance deformities after surgery. Neoplastic bone is the primary imaging feature of RIOS of esophageal cancer. By combining the patient's radiotherapy history and laboratory examinations, the diagnostic accuracy for this disease could be improved.