An analysis of 78 breast sarcoma patients without distant metastases at presentation

Purpose: A retrospective review of a single cancer center experience was un dertaken to identify clinical or treatment prognostic factors for these unu sual tumors, to allow for a recommendation regarding management. Methods and Materials: The charts of 76 women and 2 men with breast sarcoma and without distant metastases at presentation registered from 1958 to 199 0 were reviewed. Pathology was centrally reviewed in 54 cases. Histology, t umor size, grade, nodal status, age, menopausal status, history of benign b reast disease, extent of surgery, resection margins, and radiation dose wer e each examined as potential prognostic factors by univariate analysis. To allow an analysis of radiation dose, total dose was normalized to a daily f raction size of 2 Gy, Results: The median age at diagnosis was 50.5 years (13-82 years). The path ologic diagnosis was found to be malignant cystosarcoma phyllodes in 32 pat ients, with the remainder being stromal sarcoma (14), angiosarcoma (8), fib rosarcoma (7), carcinosarcoma (5), liposarcoma (4), other (8), Eighteen pat ients had grade I or II tumors, 43 had grade III or IV, and 18 were not eva luable. The 5- and 10-year actuarial rates for all 78 patients were 57% and 48% for cause-specific survival (CSS), and 47% and 42% for the relapse-fre e rates (RFR), respectively. The local relapse-free rate (LRFR) was 75% at both 5 and 10 years. The 5-year CSS for grade I or II tumors was 84% versus 55% for grade III or IV tumors (p = 0.01), Conservative surgery versus mas tectomy did not lead to statistically significant different outcomes for CS S, RFR, or LRFR, The comparison of positive versus negative margins showed a 5-year LRFR of 33% versus 80% (p = 0.009), Pairwise comparisons of the 5- year CSS of 91% for > 48 Gy versus either 50% for less than or equal to 48 Gy or 50% for no radiation showed p-values of 0.03 and 0.06, respectively. Conclusion: The authors propose that if negative surgical margins can be ac hieved, breast sarcoma should be managed by conservative surgery with posto perative irradiation to a microscopic tumoricidal dose (50 Gy) to the whole beast, and at least 60 Gy to the tumor bed. The decision to treat should b e preceded by a preoperative multidisciplinary assessment. It is also recom mended that an axillary Lymph node dissection is not indicated, with the po ssible exception of patients with carcinosarcoma. (C) 2000 Elsevier Science Inc.