Breast sarcomas. A review of the possible treatment modalities

Background. Breast sarcomas (BS) are rare tumors which origin within the connective tissue of the breast. A clear delimitation from breast carcinoma should be established because the management and evolution and prognosis are different. BS can develop “de novo” – primary BS or can be related to a previously treated malignant breast tumor – for example after breast conservative surgery and adjuvant radiotherapy. Aim. Owing to the rarity of this tumor type, there is limited evidence with regard to the optimal treatment possibilities. The information comes primary from small retrospective studies so that the treatment principles resemble that of primary mesenchymal malignancies arising in other parts of the body (e.g. leiomyosarcoma, angiosarcoma or liposarcoma). We aimed to make a review of the current treatment possibilities of the BS emphasizing on the type and extent of the surgical treatment, the utility of the axillary lymph node (LN) dissection and the feasibility and benefit of an adjuvant chemotherapy. Method. We performed an online research on Pubmed using the following key words: “sarcoma”, “radiotherapy”, “surgery”, “chemotherapy”. We tried to select the data referring to sarcoma developing with the connective tissue of the breast as well as the information of BS developing after irradiation of the breast in women previously diagnosed with breast cancer (BC) who received adjuvant radiotherapy. We further looked for reports about the role of an adjuvant treatment, namely chemotherapy. Conclusion. The only treatment proved to have a benefit on the prognosis is the surgical treatment with the achievement of a wide, radical, complete resection (R0-resection). For angiosarcomas, either primary or therapy-related, the margins of resection should be more than 1 cm for small tumors and more than 3 cm for larger tumors. Adjuvant chemotherapy has limited benefits and should be applied in selected cases.