RESUMO
BACKGROUND: Radiation-associated soft tissue sarcomas (RA-STS) are rare complications of patients receiving radiation therapy (RT) and are generally associated with a poor prognosis. Most of the literature surrounding RA-STS of the chest is centered on angiosarcoma. Therefore, we aim to document the management and outcome of patients with non-angiosarcoma RA-STS of the chest. METHODS: We reviewed 17 patients (all female, median age 65 years) diagnosed with RA-STS. The most common primary malignancy was breast carcinoma (n = 15), with a median RT dose of 57.9 Gy. All patients underwent surgical resection; five patients (29%) received radiotherapy; and five patients (29%) received peri-operative chemotherapy. RESULTS: The 5-year local recurrence and metastatic-free survival were 61% and 60%, while the 5-year disease-specific survival was 53%. Local recurrence was associated with death due to disease (HR 9.06, p = 0.01). Complications occurred in nine of patients, most commonly due to a wound complication (n = 7). At the most recent follow-up, the median Musculoskeletal Tumor Society Score was 63%. CONCLUSION: RA-STS involving the chest wall are aggressive tumors with a high risk of local relapse and death due to disease. Local recurrence was associated with death due to disease; as such, we recommend aggressive surgical management with evaluation for adjuvant therapies.
Assuntos
Recidiva Local de Neoplasia , Sarcoma , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Sarcoma/radioterapia , Sarcoma/patologia , Sarcoma/mortalidade , Sarcoma/terapia , Sarcoma/cirurgia , Recidiva Local de Neoplasia/patologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/mortalidade , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/cirurgia , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Adulto , Neoplasias Torácicas/radioterapia , Neoplasias Torácicas/patologia , Neoplasias Torácicas/mortalidade , Parede Torácica/patologia , Parede Torácica/efeitos da radiação , Seguimentos , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/terapia , Neoplasias de Tecidos Moles/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapiaRESUMO
We investigated the relationship between the lower-bound target of preventive radiation to the chest wall after modified radical mastectomy with a transverse incision and preoperative breast carcinoma characteristics to provide a basis for reducing radiation injury to neighboring tissues and individualizing preventive chest wall radiation targets. We analyzed the relationship between clinical stage, pathology, diseased region, condition of vessel tumor embolus, sex hormone levels, HER-2 expression levels, receipt of chemotherapy, and the distance of local chest wall recurrence under the edge of the transverse incision in 112 patients with local chest wall recurrence after radical mastectomy. There were 64 cases (57.1%) with local chest wall recurrence within 3 cm below the transverse incision fringe, 31 cases (27.7%) within 3-5 cm, 14 cases (12.5%) within 5-7 cm, and 3 cases (2.7%) exceeded 7 cm. There were statistically significant correlations between the distance from the focus of the chest wall recurrence to the inferior margin of the transverse incision and the T stage, HER-2 expression levels, and receipt of chemotherapy. For more than 97% of patients undergoing radical mastectomy with a transverse incision, the distance of local chest wall recurrence under the edge of the transverse incision was less than 7 cm. To accomplish individualized treatment in defining radiotherapy targets, we should pay attention to T stage, HER- 2 expression levels, and the receipt of chemotherapy when determining the lower-bound location of the target for preventive chest wall radiation after modified radical mastectomy with a transverse incision.
Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Neoplasias da Mama/patologia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Metástase Linfática , Mastectomia Radical Modificada , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Receptor ErbB-2/biossíntese , Receptor ErbB-2/genética , Parede Torácica/patologia , Parede Torácica/efeitos da radiação , Parede Torácica/cirurgiaRESUMO
Los daños severos de la pared torácica secundaria al tratamiento radiante del cáncer mamario, a pesar del avance tecnológico, todavía se observan debido a lesiones crónicas, de más de 25 años de evolución. Los autores presentan un caso clínico donde se usó para su reparación, a la mama remanente, con una técnica que tiene puntos en común con la practicada por Héctor Marino en el año 1953.
Severe damage of thoracic wall secondary to mammary cancer radiant treatment, still it is see, more than 25 years of evolution. The authors to show a case restored with other breast, similar as Argentine Master Surgeon Hector Marino executed in 1953