title: Tamoxifen in breast cancer ipse dixit in uterine malignant mixed Müllerian tumor and sarcoma-A report of 8 cases and review of the literature.
abstract: OBJECTIVE
  Report the outcome of 8 patients (pts) with breast cancer (BC) treated with Tamoxifen (TAM) that developed malignant mixed Müllerian tumor (MMMT) and rare uterine sarcoma (RUS).
  
  
  METHODS
  Retrospective study based on data collected from the department medical records between April 1999 and September 2010 among 583 pts with endometrial cancer, 36 pts with MMMT and RUS histopathology. Among them, 8 pts underwent TAM between 4 and 10 years due to a previous diagnosis of BC; all pts were post-menopausal with regular gynecological surveillance; 6 pts (75%) with abnormal uterine bleeding. The diagnosis of 6 pts (MMMT) and 2 pts (RUS) occurred at median interval of 8 years (range 4-12) after initial BC treatment. Pts underwent surgical treatment and were staged as stage I (3pts), IIIA (3pts) and IIIC (2 pts) (FIGO 1988); followed by whole pelvis irradiation (50 Gy) and intracavitary HDR brachytherapy boost (24 Gy). Two pts underwent chemotherapy (CT). Overall and disease free survival was calculated by Kaplan Meier method.
  
  
  RESULTS
  With a median follow-up of 47 months (range 17-130), 3 pts remain alive recurrence-free of BC and RUS. Four pts died with distant metastasis within the first follow-up year, without BC. One pt died from non-related cancer cause. No evidence of local recurrence was found in the whole group of pts. At two years, DFS and OS were 40% and 80%, respectively.
  
  
  CONCLUSIONS
  As reported in the literature, TAM administration and causal effect on MMMT and RUS in BC pts is still unknown. No reports about outcome from these specific pts were found.
authors.affiliation: Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Ana Luisa Cardoso
authors.initials: AL
authors.lastname: Vasconcelos
authors.affiliation: Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Nunes
authors.affiliation: Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Duarte
authors.affiliation: Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Vera
authors.initials: V
authors.lastname: Mendonça
authors.affiliation: Serviço de Oncologia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Ribeiro
authors.affiliation: Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Marília
authors.initials: M
authors.lastname: Jorge
authors.affiliation: Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal ; Serviço de Oncologia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal ; Instituto de Medicina Molecular, FMUL, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Monteiro Grillo
keywords: Breast cancer; Pelvic irradiation; Tamoxifen-related uterine sarcoma