Radiation-Induced Sarcoma of the Breast: A Systematic Review

Abstract Learning Objectives After completing this course, the reader will be able to: Evaluate the level of evidence to inform decision making for the treatment radiation induced sarcoma of the breast.Explain diagnostic criteria for radiation-induced sarcoma.Describe the effectiveness of surgery, chemotherapy and radiation therapy for radiation induced sarcoma of the breast. CME This article is available for continuing medical education credit at CME.TheOncologist.com Introduction. Radiation-induced sarcoma (RIS) is a rare, aggressive malignancy. Breast cancer survivors treated with radiotherapy constitute a large fraction of RIS patients. To evaluate evidenced-based practices for RIS treatment, we performed a systematic review of the published English-language literature. Methods. We performed a systematic keyword search of PubMed for original research articles pertaining to RIS of the breast. We classified and evaluated the articles based on hierarchal levels of scientific evidence. Results. We identified 124 original articles available for analysis, which included 1,831 patients. No randomized controlled trials involving RIS patients were found. We present the best available evidence for the etiology, comparative biology to primary sarcoma, prognostic factors, and treatment options for RIS of the breast. Conclusion. Although the evidence to guide clinical practice is limited to single institutional cohort studies, registry studies, case–control studies, and case reports, we applied the available evidence to address clinically relevant questions related to best practice in patient management. Surgery with widely negative margins remains the primary treatment of RIS. Unfortunately, the role of adjuvant and neoadjuvant chemotherapy remains uncertain. This systematic review highlights the need for additional well-designed studies to inform the management of RIS.