Breast sarcoma: Treatment
- Rashmi Chugh, MD
Rashmi Chugh, MD
- Associate Professor of Medical Oncology
- University of Michigan Medical School
- Michael S Sabel, MD
Michael S Sabel, MD
- Associate Professor of Surgery
- University of Michigan Medical School
- Mary Feng, MD
Mary Feng, MD
- Associate Professor
- University of California at San Francisco
- Section Editors
- Robert Maki, MD, PhD
Robert Maki, MD, PhD
- Section Editor — Bone and Soft Tissue Tumors
- Professor of Medicine
- Monter Cancer Center
- Hofstra-Northwell School of Medicine
- Daniel F Hayes, MD
Daniel F Hayes, MD
- Section Editor — Breast Cancer
- Professor of Medicine
- University of Michigan School of Medicine
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
- Thomas F DeLaney, MD
Thomas F DeLaney, MD
- Section Editor — Bone and Soft Tissue Tumors
- Professor of Radiation Oncology
- Harvard Medical School
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.
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 nonbreast 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 . In general, the choice of treatment is influenced by stage, histologic grade, and tumor size.
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 , 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].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL PRINCIPLES
- Management of regional nodes
- ADJUVANT RADIATION THERAPY
- Primary breast sarcomas
- - Summary
- Radiotherapy-related breast sarcomas
- ADJUVANT CHEMOTHERAPY
- NEOADJUVANT THERAPY FOR LARGE, LOCALLY ADVANCED, INITIALLY UNRESECTABLE LESIONS
- POSTTREATMENT CANCER SURVEILLANCE
- TREATMENT OF RECURRENT OR METASTATIC DISEASE
- SUMMARY AND RECOMMENDATIONS