Radiation Oncology/Sarcoma/Breast sarcoma

Breast Sarcoma

For phyllodes tumor (cystosarcoma phylloides) see Radiation_Oncology/Breast/Phyllodes

• Princess Margaret; 2000 (1958-1990) PMID 10661345 -- "An analysis of 78 breast sarcoma patients without distant metastases at presentation." (McGowan TS, Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):383-90.)
  • Retrospective. 78 pts. Included malignant phyllodes tumor (32 pts). Histologic types include stromal sarcoma, angiosarcoma, fibrosarcoma, carcinosarcoma, liposarcoma, and other. Tumors were high grade (III-IV) in 55%, low grade (I-II) in 23%; unspecified in the rest (23%).
  • Relapse-free rate: 5 yr 47%, 10 yr 42%. CSS 5 yr 57% and 10 yr 48%. Local relapse free survival 75% at 10 yrs. CSS 85% for low grade and 55% for high grade.
  • No statistical difference in outcomes for conservative surgery vs mastectomy. LRFR 33% for positive margin vs 80% for negative margin.
  • Conclusion: recommend complete excision followed by 50 Gy to the whole breast and 60 Gy to the tumor bed. Do not recommend axillary lymph node dissection except for pts with carcinosarcoma.

• MDACC; 1999 (1947-1990) PMID 10577703 -- "Role of radiotherapy in sarcoma of the breast--a retrospective review of the M.D. Anderson experience." (Barrow BJ, Radiother Oncol. 1999 Aug;52(2):173-8.)
  • Retrospective. 59 pts. Included pts with malignant sarcomas only. Excluded phyllodes tumor, carcinosarcoma, and fibromatosis. Pathology was largely malignant fibrous histiocytoma, fibrosarcoma, stromal sarcoma, and angiosarcoma. Other histologies in 17% of cases. Tumors were high grade in 42%, intermediate grade in 26%; unspecified in the rest (32%).
  • Treatment was mastectomy in 38 (64%), segmental resection in 16 (27%), or excisional biopsy (8%).
  • Tumor size and surgical margins were predictive of LF. Following mastectomy alone, LF in 34% vs 13% with mastectomy + RT. For segmental resection alone, LF in 25% (0% with RT). LF in 60% of pts with positive margins who did not receive RT. 75% of LF were in pts treated with surgery alone.
  • Conclusion: radiotherapy is probably indicated in cases with large tumor size or positive surgical margins, although no statistical benefit of RT was demonstrated.