title: Clinical manifestations and radiological features may contribute to the early diagnosis of radiation-induced sarcoma after breast cancer.
abstract: OBJECTIVE
  To describe the clinical manifestations and radiological features contributing to the early diagnosis of radiation-induced sarcoma (RIS) after radiotherapy for breast cancer.
  
  
  METHODS
  This retrospective analysis included four typical cases of RIS diagnosed at Affiliated Hospital of Academy of Military Medical Sciences between 1980 and 2013. Patient and imaging characteristics, treatment modalities, and outcomes were extracted from patients' medical records. Two pathologists reviewed all histological slides.
  
  
  RESULTS
  All four cases were misdiagnosed and treated for several months as cases of breast cancer relapse. CT using the bone-window setting and three-dimensional reconstructions clearly displayed bone tumours of RIS in three cases. Skin alterations were observed in all cases. At the time of RIS diagnosis, three patients were free of breast cancer. In one patient with bilateral breast cancer and lung metastasis, chemotherapy resulted in complete remission of the metastasis, but RIS progression. No RIS in this series responded to chemotherapy or endocrine therapy.
  
  
  CONCLUSIONS
  Abnormalities appearing in the radiation field long after RT should alert clinicians to the potential development of RIS. Careful physical examination and follow-up imaging studies are necessary. The presence of skin alterations, bone tumours at CT or radiography, and poor response to anti-cancer drugs may contribute to the early detection of RIS. Biopsy should be performed immediately when RIS is suspected.
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China.
authors.forename: X Y
authors.initials: XY
authors.lastname: Meng
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China.
authors.forename: S K
authors.initials: SK
authors.lastname: Wu
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China. Electronic address: songsantai2013@163.com.
authors.forename: S T
authors.initials: ST
authors.lastname: Song
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China.
authors.forename: T
authors.initials: T
authors.lastname: Wang
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China.
authors.forename: S H
authors.initials: SH
authors.lastname: Zhang
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China.
authors.forename: Z F
authors.initials: ZF
authors.lastname: Jiang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D003951:Diagnostic Errors; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging*; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging*; D015588:Observer Variation; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*