Sarcoma of the breast: outcome and reconstructive options.
BACKGROUND
Surgery is the mainstay of treatment for all breast sarcomas. The role of adjuvant chemotherapy and radiation therapy has not been clearly defined. The aim of this single-center retrospective study was to analyze prognostic factors, outcome, and recent advances.


METHODS
Data from 203 patients with all breast sarcomas treated in a single center were collected from 1996 to 2010. Phyllodes tumors and metastatic disease at presentation were excluded from the population. Thirty-six women and 1 man were included in the analysis. Local recurrence, metastatic disease, survival, and reconstructive outcome were evaluated.


RESULTS
Thirty-four patients out of 37 (91.9%) had an angiosarcoma and 3 had a stromal sarcoma (8.1%). Twenty-one patients (56.8%) had previously undergone breast radiation therapy for breast carcinoma or lymphoma. Twenty-six patients (70.3%) underwent mastectomy, 14 of whom (53.8%) with breast reconstruction. Thirty-six patients (97.3%) had free margins, 1 (2.7%) had a microscopically focally involved margin after surgery. Five patients received adjuvant chemotherapy and 6 received adjuvant radiation therapy. Median follow-up was 58 months (range, 4-146 months). Twelve sarcoma-related deaths were observed with a 5-year cumulative incidence of 43.4%. Twenty-four sarcoma-related events were observed with a 5-year cumulative incidence of 70.8%. The same figure was 49.7% in patients affected by primary sarcoma and 85.7% in patients with secondary sarcoma (P = .06).


CONCLUSIONS
Secondary sarcomas were associated with a higher risk of events. Patients undergoing breast conservative surgery or reconstruction after mastectomy did not show a worse prognosis compared with patients undergoing mastectomy.
Division of Senology, European Institute of Oncology, Milan, Italy. antonio.toesca@ieo.it
Antonio
A
Toesca
Gianluca
G
Spitaleri
Tommaso
T
De Pas
Edoardo
E
Botteri
Oreste
O
Gentilini
Luca
L
Bottiglieri
Nicole
N
Rotmentsz
Claudia
C
Sangalli
Emilia
E
Marrazzo
Enrico
E
Cassano
Paolo
P
Veronesi
Mario
M
Rietjens
Alberto
A
Luini
D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D002755:Choice Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods / Q000534:rehabilitation; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome