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Breast sarcoma: Treatment

Authors
Rashmi Chugh, MD
Michael S Sabel, MD
Mary Feng, MD
Section Editors
Robert Maki, MD, PhD
Daniel F Hayes, MD
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Thomas F DeLaney, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Breast sarcomas are rare, histologically heterogeneous nonepithelial malignancies that arise from the connective tissue within the breast. They can develop de novo (primary), after radiation therapy (RT), or in the setting of chronic lymphedema of the arm or breast (therapy related, secondary). Although the clinical features of breast sarcoma mimic those of breast carcinoma in some ways, therapy and prognosis differ dramatically.

GENERAL PRINCIPLES

Given the rarity of breast sarcomas, there are no prospective randomized trials to guide therapy. Treatment principles have been derived from small retrospective case reviews of breast sarcomas and extrapolated from studies of non-breast soft tissue sarcomas of the extremity and chest wall since clinical behavior, histology, and prognosis are similar.

As with soft tissue sarcomas arising in other areas of the body, a multidisciplinary approach at an experienced center involving surgical, radiation, and medical oncologists is preferred [1]. In general, the choice of treatment is influenced by stage, histologic grade, and tumor size.

SURGERY

Surgery represents the only potentially curative modality for breast sarcomas. The type and extent of the operation is based upon both the size of the tumor and the size of the breast, as well as histology:

An adequate resection margin is the single most important determinant of long-term survival with breast sarcomas [2-4]. For larger tumors (ie, those >5 cm), the overall cosmetic result is often better with a mastectomy and reconstruction than with lumpectomy. Deep seated tumors, which are close to or involve the chest wall, may require en bloc resection of the chest wall [3,5,6]. With the exception of angiosarcomas, the majority of primary breast sarcomas are not multicentric [2], and negative surgical margins are more important than the extent of surgical resection [2,7-9]. Breast angiosarcomas (primary or therapy-related) often affect a much larger field of the breast or chest wall than anticipated, and mastectomy is the standard treatment [10,11].

              

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Literature review current through: Nov 2016. | This topic last updated: Wed Feb 04 00:00:00 GMT 2015.
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