title: Radiation-induced sarcoma of the breast: a systematic review.
abstract: BACKGROUND
  Radiation-induced sarcoma (RIS) is a rare, aggressive malignancy. Breast cancer survivors treated with radiotherapy constitute a large fraction of RIS patients. To evaluate evidenced-based practices for RIS treatment, we performed a systematic review of the published English-language literature.
  
  
  METHODS
  We performed a systematic keyword search of PubMed for original research articles pertaining to RIS of the breast. We classified and evaluated the articles based on hierarchical levels of scientific evidence.
  
  
  RESULTS
  We identified 124 original articles available for analysis, which included 1,831 patients. No randomized controlled trials involving RIS patients were found. We present the best available evidence for the etiology, comparative biology to primary sarcoma, prognostic factors, and treatment options for RIS of the breast.
  
  
  CONCLUSIONS
  Although the evidence to guide clinical practice is limited to single institutional cohort studies, registry studies, case-control studies, and case reports, we applied the available evidence to address clinically relevant questions related to best practice in patient management. Surgery with widely negative margins remains the primary treatment of RIS. Unfortunately, the role of adjuvant and neoadjuvant chemotherapy remains uncertain. This systematic review highlights the need for additional well-designed studies to inform the management of RIS.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Arizona, 1501 N. Campbell Avenue, Room 4327, P.O. Box 245131, Tucson, Arizona 85724, USA.
authors.forename: Grishma R
authors.initials: GR
authors.lastname: Sheth
authors.forename: Lee D
authors.initials: LD
authors.lastname: Cranmer
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: Lauren
authors.initials: L
authors.lastname: Grasso-Lebeau
authors.forename: Julie E
authors.initials: JE
authors.lastname: Lang
mesh_terms: D005260:Female; D006801:Humans; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D011379:Prognosis; D039781:PubMed; D011878:Radiotherapy / Q000009:adverse effects; D012509:Sarcoma / Q000209:etiology / Q000473:pathology / Q000628:therapy