RADICAL RESECTION OF RADIATION-INDUCED SARCOMA OF THE CHEST-WALL - REPORT OF 15 CASES

Background. Surgical management of radiation-induced sarcoma of the ch est wall remains difficult because of its impressive local aggressiven ess. Methods. Between 1987 and 1995, 15 patients (median age, 58 years ) underwent radical resection of radiation-induced sarcoma of the ches t wall. This type of tumor was defined as a metachronous, histological ly different neoplasm in the irradiated field of the original tumor. T en patients had a history of primary breast cancer and 5 patients, Hod gkin's disease. The median delivered radiation dose to the primary tum or area was 45 Gy, and the median interval between radiotherapy and di agnosis of sarcoma was 14 years. Seven tumors were located on the ster num, three on the lateral chest wall, and five in the thoracic outlet. Four total and three partial sternectomies, three lateral chest wall resections and five resections of tumors in the thoracic outlet (three first-rib resections) were performed. Seven patients required stabili zation of the chest wall with prosthetic material. Soft tissue reconst ruction was carried out with either muscle naps and skin advancement i n 9, musculocutaneous naps in 4, or skin flaps alone in 2 patients. Re sults. One patient died 3 months after total sternectomy of respirator y failure. Two patients (13.3%) had a local complication: sepsis after sternectomy in 1 and cutaneous necrosis in 1. Local recurrence occurr ed in 7 patients after a median interval of 10 months. Two of them die d, and 4 underwent a repeat resection, 3 of whom are still alive. Four patients died of systemic recurrence. With a median follow-up of 30 m onths, overall 5-year survival and 5-year disease-free survival rates were 48% and 27%, respectively. Conclusion. Despite poor long-term dis ease-free survival, radical resection of radiation-induced sarcoma of the chest wall is justified on the basis of low postoperative morbidit y and the lack of other available therapies. (C) 1997 by The Society o f Thoracic Surgeons