Outcome and prognostic factors in breast sarcoma: A multicenter study from the rare cancer network

Oscar Lambret Anti-Cancer Center, 3 rue Frédéric Combemale, Lille, France.
Radiotherapy and Oncology (Impact Factor: 4.36). 01/2008; 85(3):355-61. DOI: 10.1016/j.radonc.2007.10.015
Source: PubMed


Breast sarcoma (BS) is a rare tumour. While surgical resection is the primary treatment, the role of radiation therapy (RT) and chemotherapy remains unclear. This study aimed at defining prognostic factors and treatment strategies.
Data from 103 patients treated between 1976 and 2002 were collected. The median age was 55 years (range: 13-86); the median histological tumour size was 4.45 cm (range: 0.8-22). There were 42 angiosarcomas. Surgery consisted of wide excision in 34 cases, and total mastectomy in 69 cases. A total dose of 50 Gy in 25 fractions was delivered in 50 patients. At the completion of treatment, 89 patients had no residual tumour.
After a median follow-up of 64 months, 56 patients developed recurrent disease: 38 presented a local relapse and 37 developed distant metastases. The 5-year disease-free survival (DFS) and overall survival (OS) were 44% (95% confidence interval [CI], 39-49%) and 55% (95% CI, 50-60%), respectively. In multivariate analysis, favourable prognostic factors for better local control were: no residual tumour after treatment, no cellular pleomorphism, and histology other than angiosarcoma. For DFS, the five favourable prognostic factors were non-menopausal status, no residual tumour after treatment, non-angiosarcoma histology, absence of tumour necrosis, and grade 1-2 histology.
While angiosarcoma has the worst prognosis, the outcome of the other types of sarcomas may be worsened by residual tumour after loco-regional treatment and high grade histology, a classical prognostic factor of the other soft tissue sarcomas. During surgical procedure axillary dissection is not mandatory.

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    • "It was believed that histologic grade is of prognostic importance, but a recent study show that there is no correlation between histologic grade and patients outcome [22]. The prognostic factors of breast angiosarcoma include the tumor size, presence of residual disease, cellular pleomorphism and proliferative index [23,24]. Aggressive surgical resection is the mainstay of treatment. "
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    ABSTRACT: Primary angiosarcoma of the breast is a rare tumour that account for fewer than 0.05% of all malignant mammary tumours. Angiosarcoma may have an perfidious clinical onset. Radiologic findings are often nonspecific and may appear completely normal in one-third of cases with primary angiosarcoma. The prognosis is usually poor because of the high rates of local recurrence and early development of metastases. Aggressive surgical resection is the mainstay of treatment. The role of adjuvant therapy has not yet been well established. Here we present a case of a 53 year old, postmenopausal women with primary angiosarcoma arising in fibroadenoma. To our knowledge, this is the first case described in the literature to date.
    Full-text · Article · Dec 2011 · Diagnostic Pathology
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    • "Although radiotherapy has not shown to improve survival, given the well-known benefit of radiotherapy in soft tissue sarcomas at other tumour sites, it is reasonable to offer postoperative radiotherapy if there is high risk of microscopic residual disease [7]. The prognostic factors for sarcoma of the breast include the tumour grade, size, presence of residual disease, and cellular pleomorphism [8, 9]. There is no definite evidence to support the use of adjuvant chemotherapy in angiosarcoma [9]. "
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    ABSTRACT: Spontaneous regression of cancer is a rare phenomenon. We present a rare case of pulmonary metastases in a 72-year-old woman with metastatic breast angiosarcoma. She was diagnosed with a breast angiosarcoma in 2005 and underwent a total mastectomy and postoperative radiotherapy. Unfortunately, a year later she was found to have multiple lung and scalp metastases but in a view of her poor general fitness, she was not a candidate for chemotherapy and was kept on regular followup. Despite the absence of any treatment, the followup chest X-ray showed a significant reduction in the number and size of lung nodules and her scalp lesions regressed completely. Seven months after the diagnosis of metastatic disease, the nodules in her scalp remain controlled.
    Full-text · Article · Feb 2008 · Sarcoma
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    ABSTRACT: ObjectiveTo investigate the clinical and pathological characteristics, diagnosis and treatment of stromal sarcoma of the breast (SSB). Methods: The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed. MethodsThe clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed. ResultsAll patients were female and one was menopausal. The median age of the patients was 39 years old (range, 20–55). All cases had a history of a palpable mass. The tumor rapidly augmented in a short time period in 3 patients. One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast. The median tumor radius was 6.0 cm (range, 3–15 cm). According to the AJCC breast cancer staging standard (6th edition), 1 case was of stage IIA, 2 cases were of stage IIB, 2 cases were of stage IIIB and one case couldn’t be staged. Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence. Radical mastectomy was suitable for those with pectoralis major muscle involvement. Two patients received simple mastectomy, 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy. After surgery, all patients were identified as SSB through pathology, with focal ossification in one case and mucinous degeneration in another one case. Four patients who underwent axillary lymph node dissection did not have lymph node metastases. Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months (8–204 months), 4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months (1 to 4 months) after surgery. One patient had lung metastases at 7 months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period. ConclusionSSB is difficult to diagnose preoperatively and is characterized by its tendency to recur locally. To obtain negative margins, wide local excision or mastectomy must be performed. Axillary lymph node dissection is not mandatory. The roles of adjuvant chemotherapy and radiotherapy have still been controversial.
    No preview · Article · Apr 2009 · Clinical Oncology and Cancer Research
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