Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer

Pierce, Susan M.; Recht, Abram; Lingos, Tania; Abner, Anthony; Vicini, Frank A.; Silver, Barbara; Herzog, Andrew G.; Harris, Jay R.

doi:10.1016/0360-3016(92)90895-o

Cited by 434 publications

(205 citation statements)

References 46 publications

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“…Our results with chemotherapy confirm that response to such treatment tends to be poor. 9,22,32,65,72,73 Kuten et al 73 reported seven patients with RIS after irradiation for breast carcinoma who were treated with a standard four-drug combination. Only 2 patients achieved partial disease remission, lasting 2 and 3 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Kirova

Vilcoq

Asselain

et al. 2005

Cancer

237

171

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BACKGROUNDSarcomas are a rare complication of radiotherapy for breast carcinoma and patients have a poor prognosis. The incidence, histology, and management of patients with sarcomas were reviewed in the current study.METHODSThe authors reviewed the records of 16,705 patients with breast carcinoma. Of these, 13,472 (81%) were treated with megavoltage radiotherapy and 3233 were treated without at the Institute Curie (Paris, France) between 1981 and 1997. Median doses of 50–55 grays (Gy) in 25–27 fractions were delivered to the whole breast over a period of 5–5.5 weeks (2 Gy/day, 5 weekly fractions) followed, when indicated, by a 16–26‐Gy boost to the tumor or tumor bed. Treatment of radiation‐induced sarcomas (RIS) consisted mostly of radical surgery and chemotherapy.RESULTSOverall, 35 patients developed sarcomas. Of these, 27 fulfilled the Cahan criteria. The median follow‐up was 9.3 years (range, 1–22.4 years). The latency period ranged from 3 years to 20.3 years. Thirteen sarcomas were located in the breast, 5– in the chest wall, 3 in the sternum, 2 in the supraclavicle, 1 in the scapula, and 3 in the axilla. Histologic evaluation identified 13 angiosarcomas, 3 osteosarcomas, 5 undifferentiated sarcomas, 1 malignant fibrous histiocytoma, 2 leiomyosarcomas, 1 fibrosarcoma, 1 rhabdomyosarcoma, and 1 myosarcoma. The cumulative RIS incidence was 0.07% (± 0.02) at 5 years, 0.27% (± 0.05) at 10 years, and 0.48% (± 0.11) at 15 years. Standardized incidence ratios were 10.2 (95% confidence interval, 9.03–11.59) for irradiated patients and 1.3 (0.3–3.6) for nonirradiated patients. Of the 27 patients, 15 died of sarcoma within 1 month to 14.5 years (mean, 34.2 ± 0.7 months). The 5‐year actuarial survival rate after diagnosis of RIS was 36% (± 0.11).CONCLUSIONSThe current study confirmed the rarity of RIS. However, it showed that the risk increased with time. Therefore, careful, long‐term follow‐up of patients treated with radiotherapy is needed for early detection and efficacious treatment of these malignancies. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Kirova

Vilcoq

Asselain

et al. 2005

Cancer

237

171

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“…The START trial suggests that 40% of women experience chest-wall discomfort at 10 years post-RT (33), whilst the incidence of rib-fracture following WBI is reported to be 0.3-2.2% (34,35). A recent study of external-beam-accelerated-PBI found the incidence of chest-wall pain and rib fracture to relate to the volume of chest-wall receiving 35Gy or more (based on 38.5Gy/10 fractions 5 days (36)).…”

Section: Lung and Chest-wall Dosimetrymentioning

confidence: 99%

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

Kirby

Evans

Donovan

et al. 2010

Radiotherapy and Oncology

151

133

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“…D ose fractionation protocols have evolved to ensure good cosmesis is a major objective and bone and soft tissue com plications are now rare, particularly at ® eld junctions, w hich were a com m on site for sarcom as to arise. 29,30,36 M any recent reports have described sarcom as arising in conserved breasts following the increased use of lum pectomy and breast irradiation as an alternative to m astectomy. T he potential risk of radiation-induced sarcom as has been a controversial issue, and three cases have been reported in over 3000 patients followed prospectively since 1973, from the M ilan C ancer Institute, the centre which reported the ® rst randomized trial in breast conservation.…”

Section: B Reast Cancermentioning

confidence: 99%

Should Cancer Survivors Fear Radiation‐Induced Sarcomas?

Feigen

1997

Sarcoma

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A bstractPurpose/Results. Ionizing radiation is carcinogenic and the induction of a second malignancy is a serious potential long-term complication of radiotherapy. The incidence of radiation-induced sarcomas was evaluated from many large epidemiological surveys of long-term cancer survivors reported in the literature over the past 30 years and only one case was found for every 1000 patients irradiated. D iscussion. Although greater numbers of cancer patients are receiving radical radiotherapy and surviving free of disease for longer intervals, cases of radiation-induced sarcomas are rare and should not deter patients from accepting radiotherapy as treatment for curable cancers. With improvements in the administration of radiotherapy over the past two decades which are resulting in less damage to bone and soft tissues, it is likely that fewer cases of this condition will be seen in the future. If these sarcomas are diagnosed early, long-term survival can be achieved with surgical excision and possibly re-irradiation, as occurs in other types of sarcomas.K ey w ords: radiation-induced sarcoma, bone sarcom a, soft tissue sarcom a.

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Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer

Cited by 434 publications

References 46 publications

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

Should Cancer Survivors Fear Radiation‐Induced Sarcomas?

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