Radiation-induced breast sarcoma

doi:10.1016/S0002-9610(02)00943-1

The American Journal of Surgery

Volume 184, Issue 4, October 2002, Pages 356-358

Presented at the Third Annual Meeting of the American Society of Breast Surgeons, Boston, Massachusetts, April 24–28, 2002.

https://doi.org/10.1016/S0002-9610(02)00943-1 Get rights and content

Abstract

Background:

The purpose of this study was to examine the presentation, treatment, and prognosis of patients with radiation-induced sarcomas after adjuvant radiotherapy for breast cancer.

Methods

This was a retrospective review from 1975 to 2001 of patients who presented with a sarcoma in an irradiated field after surgical treatment for breast cancer.

Results

Thirty-four women were included. Six had undergone breast-conserving therapy and 28 had mastectomy for primary breast carcinoma. All patients received postoperative radiation. The mean time to diagnosis of sarcoma was 152 months (range 40 to 372). Twenty-three of 34 patients (68%) had recurrence of the sarcoma after resection, and 22 patients (65%) died of their disease. Patients with no evidence of disease at follow-up had a mean tumor size of 4.2 cm ± 0.7 (n = 6), compared with 8.1 cm ± 1.2 (n = 10) for patients who died of their disease (P = 0.030).

Conclusions

Radiation-induced sarcoma is a late complication of definitive treatment for breast carcinoma. The prognosis of such patients is poor, with two thirds dying of their disease. In the present series, improved survival was associated with smaller tumor size at presentation.

Section snippets

Methods

For the present study, retrospective chart reviews of patients diagnosed from 1975 to 2001 at the Mayo Clinic with a sarcoma in an irradiated field after breast-conserving surgery, modified radical mastectomy, or radical mastectomy for a primary breast adenocarcinoma were performed. All patients received adjuvant radiotherapy, 5,000 to 6,000 cGy, within 3 months after surgery. Follow-up data on all patients were obtained. Statistical analyses were performed by JMP software, version 4.0.4,

Results

The mean age of patients at the time of the original breast carcinoma was 49.7 years (range 23 to 80). The mean age at presentation of radiation-induced sarcoma was 62.3 years (range 38 to 86), with the mean latent time interval from post-operative adjuvant radiotherapy being 152 months (range 40 to 372). The histopathology of the sarcomas included: angiosarcoma (n = 12), malignant fibrous histiocytoma (n = 11), osteogenic sarcoma (n = 5), fibroblastic sarcoma (n = 4), and other (n = 2).

In the

Comments

Determining the best treatment of radiation-induced sarcomas has been problematic, due to the low rate of occurrence. A review from Barrow et al [6] was unable to show a role for adjuvant radiotherapy for breast sarcoma. Similarly, chemotherapy has not proved to be efficacious [7]. In the present study, 9 patients received chemotherapy in addition to surgical treatment, and only 2 were alive at follow-up. Five patients received radiation therapy plus surgery, with only 1 survivor. Four patients

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The major prognostic factor is tumor size at diagnosis. Other prognostic factors described in the literature are the degree of histological differentiation and the limits of surgical excision [10]. The prognosis of these tumors remains poor with a five-year overall survival rate of 30% [11].
Breast angiosarcomas are rare and aggressive conjunctival malignancies. They represent 0.04% of malignant breast tumors and 8–10% of all breast sarcomas. There are two forms; a primary one with no known precursor, and one secondary to breast irradiation.
Patient aged 63 years, mother of four, known hypertensive on treatment, operated 07 years ago by right breast conservative surgery with at pathology report; CMI type NOS, grade II SBR, endoluminal B, (0 N+/10 N). The patient received chemotherapy, radiotherapy and hormone therapy for 5 years.
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Radiotherapy also does not present a clear consensus and should be considered as adjuvant treatment in selected cases. Examining the data regarding disease free survival and overall survival, we would like to mention Blanchard study in which the author compared the outcome for patients with different histological types of breast sarcoma presenting a median disease free survival (DFS) of 25 months [4]. Rosen et al. presented a 5-year disease-free survival ranging from 15% for patients with high-grade tumors to 76% for those with low-grade tumors [9].
Primary angiosarcoma (AS) of the breast is a rare neoplasia that is not related to radiation exposure. It represents less than 0.05% of all malignant breast tumors. This lesion is characterized by aggressive patterns and poor prognosis and by the absence of typical features at radiologic examination.
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Radiation-associated angiosarcoma (RAAS) of the breast is a rare, aggressive disease. The incidence is increasing with the prolonged survival of women irradiated for primary breast cancer. Surgery is the current treatment of choice. Prognosis is poor. This review aims to evaluate all publications on primary treatment of RAAS to identify prognostic factors and evaluate treatment modalities.
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Scientific paperRadiation-induced breast sarcoma

Abstract

Background:

Methods

Results

Conclusions

Section snippets

Methods

Results

Comments

Eur J Cancer

Int J Radiat Oncol Biol Phys

J Am Coll Surg

Scientific paper
Radiation-induced breast sarcoma