Multidisciplinary treatment of therapy-associated sarcomas of the breast and chest wall

Secondary malignancies after successful treatment of a primary tumor are rare and require individual treatment approaches due to the previous treatment. Here, we describe treatment approaches for sarcomas associated with radiation and lymphedema.

From the Sarcoma Center database, we extract three typical cases of radiation-induced angiosarcoma after breast cancer, lymphedema-associated angiosarcoma, and radiation-induced pleomorphic sarcoma of the chest wall.

For the treatment of radiation-induced angiosarcoma, which occurred 11 years after mastectomy and adjuvant radiotherapy for breast cancer in an 84-year-old female patient, we performed preoperative chemotherapy with paclitaxel (4 cycles) and a wide resection with meshgraft reconstruction. The pathological response was 100%. Eight months after surgery, the patient developed multiple metastases and died under palliative care. We performed an isolated limb perfusion with rhTNF-alpha and melphalan for the treatment of an angiosarcoma associated with lymphedema (Stewart-Treves Syndrome), which occurred eight years after axillary dissection and radiation with post-therapeutic lymphedema. TNF-ILP alone led to a clinically complete response and avoidance of an amputation of the right arm. For the treatment of radiation-induced pleomorphic sarcoma 48 years after cobalt radiation for a melanoma of the chest wall, we indicated re-radiation and subsequent R0 resection (marginal at the brachial plexus) as well as plastic reconstruction with free flap surgery.

Interdisciplinary, multimodal treatment approaches tailored to histological subtype offer the possibility of function-preserving therapy even for locally advanced, therapy-associated sarcomas. Multiprofessional cooperation improves patient outcome and promotes research in rare cancers.

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Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2025