title: Long-term risk of sarcoma following radiation treatment for breast cancer.
abstract: Between 1954 and 1983, 7620 patients were treated for breast carcinoma at Institut Gustave Roussy (France). Of these patients, 6919 were followed for at least 1 year. Out of these, 11 presented with sarcomas thought to be induced by irradiation, 2 of which were Steward-Treves Syndrome, and 9 of which were sarcomas within the irradiated fields. All histological slides were reviewed and a comparison with those of breast cancer was done. The sites of these sarcomas were: parietal wall, 1 case; second costal cartilage, 1 case; infraclavicular region, 1 case; supraclavicular region, 2 cases; internal third of the clavicle, 2 cases; axillary region 2 cases; and the internal side of the upper arm (Stewart-Treves syndrome), 2 cases. The median age of these 11 patients at the diagnosis of sarcomas was 65.8 (49-83). The mean latent period was 9.5 years (4-24). Three patients underwent radical mastectomy and nine modified radical mastectomy. Only one patient received chemotherapy. The radiation doses received at the site of the sarcoma were 45 Gy/18 fr. for 10 cases and 90-100 Gy for 1 case (due to overlapping between two fields). The histology was as follows: malignant fibrous histiocytoma, 5 cases; fibrosarcoma, 3 cases; lymphangiosarcoma, 2 cases; and osteochondrosarcoma, 1 case. The median survival following diagnosis of sarcoma was 2.4 years (4 months-9 years). Two patients are still alive: one with recurrence of her breast cancer, the other in complete remission, with 7 and 3 years follow-up, respectively. All other patients died from their sarcomas. The cumulative incidence of sarcoma following irradiation of breast cancer was 0.2% (0.09-0.47) at 10 years. The standardized incidence ratio (SIR) of sarcoma (observed n# of cases (Obs)/expected n# of cases (Exp) computed from the Danish Cancer Registry for the same period) was 1.81 (CI 0.91-3.23). This is significantly higher than one, with a p = 0.03 (One Tailed Exact Test). The mean annual excess (Obs-Exp)/100.000 person-years at risk during the same period/(100,000) was 9.92. This study suggests that patients treated by radiation for breast cancer have a risk of subsequent sarcomas that is higher than the general population. However, the benefit from adjuvant radiation therapy in the treatment of breast cancer exceeds the risk of second cancer; therefore, the potential of radiation-induced sarcomas should not be a factor in the selection of treatment for patients with breast cancer.
authors.affiliation: Department of Radiation Therapy, Institut Gustave Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Taghian
authors.forename: F
authors.initials: F
authors.lastname: de Vathaire
authors.forename: P
authors.initials: P
authors.lastname: Terrier
authors.forename: M
authors.initials: M
authors.lastname: Le
authors.forename: A
authors.initials: A
authors.lastname: Auquier
authors.forename: H
authors.initials: H
authors.lastname: Mouriesse
authors.forename: E
authors.initials: E
authors.lastname: Grimaud
authors.forename: D
authors.initials: D
authors.lastname: Sarrazin
authors.forename: M
authors.initials: M
authors.lastname: Tubiana
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D005260:Female; D005354:Fibrosarcoma / Q000453:epidemiology / Q000209:etiology; D005602:France / Q000453:epidemiology; D018219:Histiocytoma, Benign Fibrous / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008204:Lymphangiosarcoma / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D012516:Osteosarcoma / Q000453:epidemiology / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012509:Sarcoma / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors