SARCOMA OF THE BREAST - IMPLICATIONS FOR EXTENT OF THERAPY - THE M. D. ANDERSON EXPERIENCE

Background. Sarcoma of the breast is a rare clinical entity for which there are no prospective data about extent of surgery indicated or rol e of multimodality therapy. The purpose of this study was to examine o ne of the largest single institutional experiences to shed light on th ese clinical issues. Methods. This study retrospectively reviewed 60 c ases of sarcoma of the breast (cystosarcoma phyllodes excluded). Resul ts. For the entire series there was a median overall survival time (OS ) of 67 months and a disease-free survival period (DFS) of 18 months. Tumors smaller than 5 cm were associated with a better DFS (p < 0.04) and OS (p < 0.009). Patients with tumors less than 5 cm in diameter di d equally well whether treated by wide local excision or mastectomy. A ngiosarcoma histologic characteristics were associated with longer OS than stromal sarcoma (p = 0.017), malignant fibrous histiocytoma (p = 0.075), or fibrosarcoma (p = 0.08). Axillary dissections did not recov er any nodal metastases were always and only in the context of dissemi nated disease. Adjuvant chemotherapy and/or radiotherapy was associate d with prolonged DFS (p = 0.015). There was a trend toward improved lo cal control with adjuvant radiotherapy (p = 0.14). Conclusions. Lesion s less than 5 cm should be treated by breast-preserving wide local exc ision, and adjuvant radiotherapy should be considered for selected sub groups. For tumors 5 cm or larger, a more aggressive approach seems ap propriate; consideration should be given to neoadjuvant chemoradiation followed by margin-negative surgery (if possible). There is no demons trable staging or therapeutic role for routine axillary dissection.