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Sarcoma of the chest wall after radiotherapy for breast carcinoma – a case report


Authors: I. Zedníková 1;  J. Šafránek 1;  M. Hlaváčková 2;  O. Hes 3;  T. Svoboda 4
Authors place of work: Chirurgická klinika FN Plzeň-Lochotín, přednosta: prof. MUDr. V. Třeška, DrSc. 1;  Klinika zobrazovacích metod FN Plzeň-Lochotín, přednosta: doc. MUDr. B. Kreuzberg, CSc. 2;  Šiklův patologicko-anatomický ústav FN Plzeň, přednosta: prof. MUDr. M. Michal 3;  Onkologické a radioterapeutické oddělení FN Plzeň, přednosta: prof. MUDr. J. Fínek, Ph. D. 4
Published in the journal: Rozhl. Chir., 2014, roč. 93, č. 7, s. 396-400.
Category: Case Report

Summary

Introduction:
Sarcoma occurring in soft tissues after radiotherapy is a rare complication of radiation treatment of tumours. It was most often described after treatment for breast cancer as well as for non-Hodgkin lymphoma and cervical carcinoma. The time interval between the radiation therapy and the development of the sarcoma can be very wide. Treatment demands radical surgical resection of the sarcoma with the edge of the resected tissue without tumour cells. In some cases, this is followed by chemotherapy or radiotherapy. The median survival time is 23 months, the longest survival being associated with sarcomas removed in a radical way.

Case report:
We present the case of a female patient with recurring leiomyosarcoma of the chest wall after radiotherapy for cancer of the right breast. In 2006, this 62-year-old patient was operated on to keep her right breast with axilla exenteration. After the surgery, hormonal therapy was followed by adjuvant radiotherapy of the right breast and the adjacent axilla. We used a linear accelerator and the total amount of radiation was 50 Gy (2 Gy fractionally once a day, five days a week). Four years after the operation, leiomyosarcoma was diagnosed in the pectoral muscle at the site where the tumour of the right breast had been excised. Between 2011 and 2013, a total of five operations of reoccurring sarcoma were performed – two excisions of the tumour, a mastectomy, rib resection and, at last, block resection of the chest wall. Adjuvant oncological treatment was not indicated. The patient, now being 69 years old, is still in a good physical and mental condition without any generalization of the disease.

Conclusion:
Sarcoma of the chest wall is a relatively rare consequence of radiotherapy for breast cancer. Sarcoma treatment involves radical surgical resection of the tumour whenever possible. The surgery is mostly followed by radiotherapy which, however, is impossible in a patient after breast-preserving surgery for carcinoma with radiotherapy. Chemotherapy is not very effective in sarcomas. Therefore, the operation needs to be performed by an experienced surgeon in a sufficiently radical way.

Key words:
breast cancer – radiotherapy – sarcoma after radiotherapy


Zdroje

1. Žaloudík J. Chirurgické aspekty léčby sarkomů měkkých tkání. Onkologie 2010;4:297−301.

2. Berg JW, Hutter RV. Breast cancer. Cancer 1995;75:257−259.

3. Mark RJ, Poen J, Tran LM, et al. Postradiation sarcoma: A single institution study nad review of the literature. Seminars in Oncology 1997;24:504−514.

4. Vojtíšek R, Kinkor Z, Fínek J. Sekundární angiosarkomy po konzervativní léčbě nádorů prsu, Klin Onkol 2011;24:382−388.

5. Laskin WB, Silverman TA, Enzinger FM. Postradiation soft tissue sarcoma: A analysis of 53 cases. Cancer 1994;73:2653−2662.

6. Karlsson P, Holmberg E, Johansson KA, et al. Soft tissue sarcoma after treatment for breast cancer. Radiother Oncol 1996;38:25−31.

7. Lagrange JL, Ramaioli A, Chateau MC, et al. Sarcoma after radiation therapy: retrospective multiinstitutional study of 80 histologically confirmed cases. Radiology 2000;216:197−200.

8. Blanchard DK, Reynolds C, Grant CS, et al. Radiation-induced breast sarcoma. Am J Surg 2002;184:356−358.

9. Huang J, Mackillop WJ. Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma. Cancer 2001;92:172−180.

10. McGowan TS, Cummings BJ, O´Sullivan B, et al. An analysis of 78 breast sarcoma patients without distant metastases at presentation. Int J Radiat Oncol Biol Phys 2000;46:383−390.

11. Yamashina M. Primary Leiomyosarcoma in the Breast. Japanese Journal of Clinical Oncology 1987;17:71−77.

12. Markaki S, Sotiropoulou M, Hanioti C, Lazaris D. Leiomyosarcoma of the breast – A clinicopathologic and immunohistochemical study. European Journal of Obstetrics and Gynecology and Reproductive Biology 2003;2:233−236.

13. Shinto O, Yashiro M, Yamada N, Matsuoka T, Ohira M, et al. Primary Leiomyosarcoma of the Breast: Report of a Case. Surgery Today 2002;8:716−719.

14. Yap J, Chuba PJ, Thomas R, et al. Sarcoma as a second malignancy after treatment for breast cancer. International Journal of Radiation Oncology Biology Physics 2002;52:1231−1237.

15. Kirova YM, Vilcoq JR, Asselain B, Sastre-Garau X, Fourquet A. Radiation-induced sarcomas after radiotherapy for breast carcinoma: a large-scale single-institution review. Cancer 2005;68:356−363.

16. Kuten A, Sapir D, Cohen Y, Haim N, Borovik R, et al. Postirradiation soft tissue sarcoma occuring in breast cancer patients: report of seven cases and results of combination chemotherapy. Journal of Surgical Oncology 1985;28:168−171.

17. Olicina M, Merck B, Gimenez-Climent MJ, Almenar S, Sancho-Merle MF, et al. Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction. Sarcoma 2008:3 pages.

Štítky
Surgery Orthopaedics Trauma surgery
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