No abstract

No abstract

BACKGROUNDSarcomas are a rare complication of radiotherapy for breast carcinoma and patients have a poor prognosis. The incidence, histology, and management of patients with sarcomas were reviewed in the current study.METHODSThe authors reviewed the records of 16,705 patients with breast carcinoma. Of these, 13,472 (81%) were treated with megavoltage radiotherapy and 3233 were treated without at the Institute Curie (Paris, France) between 1981 and 1997. Median doses of 50–55 grays (Gy) in 25–27 fractions were delivered to the whole breast over a period of 5–5.5 weeks (2 Gy/day, 5 weekly fractions) followed, when indicated, by a 16–26‐Gy boost to the tumor or tumor bed. Treatment of radiation‐induced sarcomas (RIS) consisted mostly of radical surgery and chemotherapy.RESULTSOverall, 35 patients developed sarcomas. Of these, 27 fulfilled the Cahan criteria. The median follow‐up was 9.3 years (range, 1–22.4 years). The latency period ranged from 3 years to 20.3 years. Thirteen sarcomas were located in the breast, 5– in the chest wall, 3 in the sternum, 2 in the supraclavicle, 1 in the scapula, and 3 in the axilla. Histologic evaluation identified 13 angiosarcomas, 3 osteosarcomas, 5 undifferentiated sarcomas, 1 malignant fibrous histiocytoma, 2 leiomyosarcomas, 1 fibrosarcoma, 1 rhabdomyosarcoma, and 1 myosarcoma. The cumulative RIS incidence was 0.07% (± 0.02) at 5 years, 0.27% (± 0.05) at 10 years, and 0.48% (± 0.11) at 15 years. Standardized incidence ratios were 10.2 (95% confidence interval, 9.03–11.59) for irradiated patients and 1.3 (0.3–3.6) for nonirradiated patients. Of the 27 patients, 15 died of sarcoma within 1 month to 14.5 years (mean, 34.2 ± 0.7 months). The 5‐year actuarial survival rate after diagnosis of RIS was 36% (± 0.11).CONCLUSIONSThe current study confirmed the rarity of RIS. However, it showed that the risk increased with time. Therefore, careful, long‐term follow‐up of patients treated with radiotherapy is needed for early detection and efficacious treatment of these malignancies. Cancer 2005. © 2005 American Cancer Society.

No abstract

The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed.

No abstract

The aims of this study were to define the initial pathological and clinical characteristics, and prognostic factors of patients with primary breast malignant lymphoma (PBL). All patients treated at the Institut Curie for lymphoma with breast involvement were reviewed. A pathological review of all cases was performed. Fortyfive cases were selected in whom 38 cases were of diffuse large B-cell lymphoma. A complete analysis was then performed on these 38 patients. Twenty out of 28 cases (71%) of cases were Bcl-2 positive and four out of 28 (14%) had a CD10 positive staining. Peculiar initial characteristics showed nodal involvement in 58% of the cases and two or more extra-nodal sites in 31% of the cases. Among the 37 patients for whom all data were available, and according to the International Prognostic Index, 19 patients (51%) were classified in the low-risk group, 5 cases (14%) in the low-to intermediate-risk group, 6 patients (16%) in the intermediate-to high-risk group, and 7 (19%) case in the high-risk group. At the end of initial therapy, 34 patients (89%) achieved CR. With a median follow-up of 96 months, 18 patients (47%) relapsed of whom 3 had a relapse in central nervous system site. The 5-year disease-free (DFS) and overall survivals (OS) were 54% and 61%, respectively. In multivariate analysis, the presence of 2 or more extranodal sites was prognostic for lower DFS (P 5 0.0008) and OS (P 5 0.09), and a performance status ‡1 was prognostic for lower OS (P 5 0.005). Finally, when our series was compared with a historical series of 111 patients with aggressive nodal lymphomas, we observed significant lower survival rates in localized PBL (P < 0.03). Initial breast localization has a pejorative impact on the outcome of patients with Non-Hodgkin's Lymphoma (NHL), with an impressive adverse influence of additional extranodal sites. These results suggest a specific management of NHL with breast involvement. Am. J. Hematol. 84:133-139, 2009. V

No abstract