Secondary Lower-Body Sarcomas in Cervical Cancer Survivors Following Surgery, Radiotherapy, or Both - A Population-Based Study

Q: What was the study’s primary aim regarding secondary sarcomas?

The study investigated the incidence and subtypes of secondary sarcomas by treatment modality, prognosis, and whether surgery plus radiotherapy increases angiosarcoma incidence.

Q: How was the cohort constructed and which patients were excluded?

The study analyzed Osaka Cancer Registry data for women aged 20–84 diagnosed with cervical cancer (1980–2015). Patients with distant metastases, survival time under 1 year, or missing data were excluded.

Q: Which treatment approach showed higher secondary lower-body sarcoma incidence?

Radiotherapy alone or combined with surgery increased secondary lower-body sarcoma incidence compared with surgery, and angiosarcoma incidence was higher with surgery plus radiotherapy than with radiotherapy alone.

Sep 29, 2026

Uploaded by Liam

Secondary sarcomas in cervical cancer survivors remain understudied. This population-based retrospective cohort study used Osaka Cancer Registry data from women aged 20–84 diagnosed with cervical cancer between 1980 and 2015 and treated with surgery, radiotherapy, or both. Exclusions included distant metastases, survival time under 1 year, or missing data. Among included patients, sarcomas occurred more often after radiotherapy combinations. At 10 years, cumulative incidence was higher for surgery plus radiotherapy than for surgery. Angiosarcoma incidence increased with surgery plus radiotherapy and radiotherapy. Radiotherapy, alone or combined, raised secondary lower-body sarcoma incidence compared with surgery, suggesting an association between combined treatment and angiosarcoma.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Abstract

Introduction

Material and Methods

Study Design and Participants

Cancer Science ORIGINAL ARTICLE OPEN ACCESS Secondary Lower-Body Sarcomas in Cervical Cancer Survivors Following Surgery, Radiotherapy, or Both: A Population-Based Study Toshiki Ikawa1,2 | Kayo Nakata1 | Toshitaka Morishima1 | Ken-ichi Yoshida3 | Yoshihiro Kuwabara1 | Mizuki Shimadzu Kato1 | Yoko Iwaki1 | Naoyuki Kanayama2 | Masahiro Morimoto2 | Koji Konishi2 | Isao Miyashiro1 1Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan | 2Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan | 3Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan Correspondence: Toshiki Ikawa ([t_ikawa@radonc.med.osaka-u.ac.jp](t_ikawa@radonc.med.osaka-u.ac.jp)) Received: 30 April 2025 | Revised: 22 September 2025 | Accepted: 8 October 2025 Funding: This work was supported by the Grant-in-Aid for Early-Career Scientists from the Japan Society for the Promotion of Science KAKENHI [JP20K18952, JP25K19187]. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Keywords: angiosarcoma | cervical neoplasms | radiation-associated | radiation-induced | second primary neoplasm ABSTRACT Secondary sarcomas in cervical cancer survivors are understudied. We investigated the incidence and subtypes of secondary sarcomas by treatment modalities, the prognosis of secondary sarcomas, and whether surgery plus radiotherapy increases angiosarcoma incidence. This population-based retrospective cohort study analyzed Osaka Cancer Registry data on women aged 20–84 years diagnosed with cervical cancer (1980–2015), treated with surgery, radiotherapy, or both. Patients with distant metastases, survival time < 1year, or missing data were excluded. We included 7591 patients with invasive cancer treated with surgery, 3882 with radiotherapy, and 4090 with surgery plus radiotherapy and 13,205 with carcinoma in situ treated with surgery. We assessed the first lower-body sarcoma occurrence ≥1 year post-diagnosis. Sarcomas developed in 6 patients treated with surgery (0 angiosarcomas), 10 with radiotherapy (1 angiosarcoma), and 19 with surgery plus radiotherapy (9 angiosarcomas). At 10 years, the cumulative incidence was 0.083%(95% confidence interval [CI], 0.024%–0.24%) for radiotherapy and 0.21%(95% CI, 0.10%– 0.41%) for surgery plus radiotherapy, higher than that for surgery (invasive, 0.013%; in situ, 0.028%) (p < 0.001) . Angiosarcoma incidence was higher with surgery plus radiotherapy (0.080%; 95% CI, 0.023%–0.23%) than with radiotherapy (0.028%; 95% CI, 0.003%–0.16%) (p = 0.029). Among patients diagnosed with sarcoma after radiotherapy or surgery plus radiotherapy, the 1-year overall survival rate was 33.3%(95% CI, 19.6%–56.8%) . Radiotherapy, alone or combined with surgery, increased secondary lower-body sarcoma incidence compared with surgery. To our knowledge, this is the first population-based study to suggest that surgery plus radiotherapy is associated with angiosarcoma in cervical cancer survivors. 1 | Introduction Cervical cancer remains a common malignancy among women worldwide, despite being preventable through vaccination against human papillomavirus and screening [1, 2] . Although preventive measures have reduced incidence and mortality rates in some countries, resource-limited regions continue to face challenges, with rising incidence in certain areas [2] . Standard treatment for non-metastatic cervical cancer includes radical surgery with adjuvant radiotherapy based on pathological risk | Abbreviations: CI, confidence interval; CIS, carcinoma in situ; GIST, gastrointestinal stromal tumor; ICD-O-3, International Classification of Diseases for Oncology third edition; IQR, interquartile range; RR, relative risk; SIR, standardized incidence ratio. | | --- | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License

FAQs

What was the study’s primary aim regarding secondary sarcomas?

The study investigated the incidence and subtypes of secondary sarcomas by treatment modality, prognosis, and whether surgery plus radiotherapy increases angiosarcoma incidence.

How was the cohort constructed and which patients were excluded?

The study analyzed Osaka Cancer Registry data for women aged 20–84 diagnosed with cervical cancer (1980–2015). Patients with distant metastases, survival time under 1 year, or missing data were excluded.

Which treatment approach showed higher secondary lower-body sarcoma incidence?

Radiotherapy alone or combined with surgery increased secondary lower-body sarcoma incidence compared with surgery, and angiosarcoma incidence was higher with surgery plus radiotherapy than with radiotherapy alone.

Sep 29, 2026

Uploaded by Liam