Sarcoma as a second malignancy after treatment for breast cancer

Yap, J.; Chuba, Paul J.; Thomas, Robert A.; Aref, Amr; Lucas, David R.; Severson, Richard K.; Hamre, Merlin

doi:10.1016/s0360-3016(01)02799-7

Cited by 231 publications

(166 citation statements)

References 21 publications

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“…Our cumulative RIS incidence was highly similar to those reported in an earlier single-center French study comprising a smaller population of patients 22 and in a recent large-scale study on registry data. 23 Although RT increases the absolute risk of a sarcoma, other factors such as chronic lymphedema were found to be related to the increased risk of sarcoma. 49,50 To our knowledge, Stewart and Treves 49 were the first to describe cases of angiosarcoma occurring in lymphoedematous extremities after radical mastectomy.…”

Section: Discussionmentioning

confidence: 96%

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: 96%

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Kirova

Vilcoq

Asselain

et al. 2005

Cancer

237

171

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“…The results of this study are consistent with the few previous studies of angiosarcoma after radiotherapy. In a SEER data study of second malignancies among 270 000 breast cancer patients, angiosarcomas were found to comprise 56.8% of the sarcomas occurring in the field of prior radiation (Yap et al, 2002). In a population-based retrospective cohort study of 195 000 breast carcinoma patients, an increased risk of soft tissue sarcoma was found, especially for angiosarcoma: SIR 26.2 (95% CI 16.5 -41.4) in the radiotherapy cohort with an increased relative risk (RR 15.9, 95% CI 6.6 -38.1) compared to those not so treated (Huang and Mackillop, 2001); the SIRs were lower in our study, with no excess after radiotherapy compared with other treatments.…”

Section: Discussionmentioning

confidence: 99%

“…In our previous study, radiotherapy was found to be a risk factor for subsequent bone and soft tissue sarcoma (Virtanen et al, 2006). Ionising radiation is one of the few known causes of angiosarcoma (Miller et al, 1996;Zahm et al, 1996;Huang and Mackillop, 2001;Fletcher et al, 2002;Yap et al, 2002). We have investigated the risk of angiosarcoma in relation to chemotherapy and radiotherapy in a large, populationbased cohort of cancer patients.…”

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confidence: 96%

Angiosarcoma after radiotherapy: a cohort study of 332 163 Finnish cancer patients

2007

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We evaluated the risk of angiosarcoma after radiotherapy among all patients with cancers of breast, cervix uteri, corpus uteri, lung, ovary, prostate, or rectum, and lymphoma diagnosed in Finland during 1953Finland during -2003, identified from the Finnish Cancer Registry. Only angiosarcomas of the trunk were considered, this being the target of radiotherapy for the first cancer. In the follow-up of 1.8 million person-years at risk, 19 angiosarcomas developed, all after breast and gynaecological cancer. Excess of angiosarcomas over national incidence rates were observed after radiotherapy without chemotherapy (standardised incidence ratio (SIR) 6.0, 95% confidence interval (CI) 2.7 -11), after both radiotherapy and chemotherapy (SIR 100, 95% CI 12 -360), and after other treatments (SIR 3.6, 95% CI 1.6 -7.1). In the regression analysis however, the adjusted rate ratio for radiotherapy was 1.0 (95% CI 0.23 -4.4). Although an increased risk of angiosarcoma among cancer patients is evident, especially with breast and gynaecological cancer, the excess does not appear to be strongly related to radiotherapy.

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“…The prognosis for patients with RAS is poor and is comparable to the prognosis for patients with sporadic soft tissue sarcoma according to most authors, although Gladdy et al reported a worse prognosis for 130 patients who had RAS compared with their entire cohort of >7000 patients who had sporadic soft tissue sarcomas. 3,4,8 This may be because of a higher rate of incomplete resections caused by multifocal disease and the less frequent use of adjuvant radiotherapy for patients with RAS in their series. 8 The median latency period ranges from 59 to 103 months in the literature, which is in line with our data.…”

Section: Discussionmentioning

confidence: 99%

“…8,[24][25][26][27][28] RAS may be of any type, but angiosarcoma was the most common in our patient group and in other series of thoracic RAS. [2][3][4]19,22 Angiosarcoma may be associated with chronic lymphedema of a limb or of the chest wall (Stewart-Treves [ST] syndrome), which is diagnosed most frequently after axillary lymph node dissection as a part of breast cancer treatment and can occur in the lymphedematous arm itself or in the shoulder, axillary, or chest wall region. The latency period of ST syndrome appears to be 10 to 12 years, slightly longer than that for RAS.…”

Section: Discussionmentioning

confidence: 99%

Reirradiation and hyperthermia for radiation‐associated sarcoma

Jong

Oldenborg

Oei

et al. 2011

Cancer

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BACKGROUND:The objective of this study was to evaluate the role of reirradiation and hyperthermia in the treatment of radiation-associated sarcoma (RAS) in the thoracic region, which is an increasing, yet extremely rare condition with a poor prognosis. METHODS: Between 1979 and 2009, 16 patients with RAS in the thoracic region were treated in the Academic Medical Center and the Institute Verbeeten with reirradiation and hyperthermia. In 13 patients, this treatment was given for unresectable disease and 3 times after resection as adjuvant treatment. The median latency period between the original malignancy diagnosis and the RAS diagnosis was 86 months (range 19-212 months). Histology was angiosarcoma in 11 patients (69%). The literature on reirradiation with or without hyperthermia for RAS was reviewed. RESULTS: The median survival was 15.5 months (range, 3-204 months). Four patients were not evaluable for response. The response rate for the remaining 12 patients was 75% (7 complete responses and 2 partial responses). Six patients remained free of local failure until death (5 months and 7 months) or last follow-up (8 months, 11 months, 39 months, and 68 months). CONCLUSIONS: The current study indicates that combined reirradiation and hyperthermia for RAS in the thoracic region is feasible. The high response rate and the possibility of durable local control suggest that this treatment is promising. Cancer 2012;118:180-

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Sarcoma as a second malignancy after treatment for breast cancer

Cited by 231 publications

References 21 publications

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Radiation‐induced sarcomas after radiotherapy for breast carcinoma

Angiosarcoma after radiotherapy: a cohort study of 332 163 Finnish cancer patients

Reirradiation and hyperthermia for radiation‐associated sarcoma

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