title: Long-term survival after radical operations for cancer treatment-induced sarcomas: how two survivors invite reflection on oncologic treatment concepts.
abstract: Extent and radicality of surgical oncologic treatment has changed in the past 30 years. Two patients with node-positive breast cancer are presented, who underwent (total or radical) mastectomy with lymphadenectomy and postoperative radiation 24 and 40 years ago. A radiation-associated sarcoma of the parascapular soft tissue developed in one patient 9 years after treatment; the other one sought treatment for a lymphedema-associated Stewart-Treves lymphangiosarcoma 16 years after initial therapy. Both patients underwent a forequarter amputation for their treatment-associated high-grade sarcoma. Both are currently alive and cancer-free 15 and 24 years after amputation. These reports remind us that radical locoregional treatment can cure some solid cancers in the absence of systemic therapy; that such extensive treatment may induce significant disability or secondary malignancies long-term; that even advanced treatment-associated sarcomas can be cured with aggressive resection; that today's multimodality therapy approaches and appropriate patient selection have rendered such extensive locoregional treatment for many tumors obsolete or unnecessary; and that if no effective alternative treatment exists and organ or limb preservation is not feasible, an aggressive resection approach for high-grade cancer should not be discounted unless systemic failure is certain or imminent.
authors.affiliation: Department of General Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA.
authors.forename: Roderich E
authors.initials: RE
authors.lastname: Schwarz
authors.forename: Georg
authors.initials: G
authors.lastname: Hillebrand
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Peralta
authors.forename: David Z J
authors.initials: DZ
authors.lastname: Chu
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Weiss
mesh_terms: D000671:Amputation, Surgical; D001132:Arm / Q000601:surgery; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008204:Lymphangiosarcoma / Q000601:surgery; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000601:surgery*