Radiation‐induced sarcoma after treatment of breast cancer

Two case reports are presented of radiation‐induced sarcomas occurring 23 years and 7 years after radiotherapy for breast carcinoma. One patient developed an undifferentiated sarcoma of the scapula believed to be induced by a calculated dose to the soft tissue component of bone of 8,195 rads in 3 weeks. The second patient had a fibrosarcoma involving the soft tissues of the axilla. Both patients died several months after diagnosis of the second neoplasm. A review of the literature disclosed 12 other cases in which a malignant tumor developed under similar circumstances. An analysis of these 12 cases and the 2 reported here showed that the most frequent site for the development of a malignant tumor was the scapula, and osteogenic sarcoma was the predominant histologic type encountered in these cases. Treatment with radical surgery or radiation was usually unsuccessful because most patients developed metastases early. A study of the reported cases brought out the fact that incompletely reported dosages made it impossible to calculate accurately doses of radiation absorbed in the target tissues. The authors present a scheme for presenting precise and informative physical data when future cases of radiation‐induced tumors are encountered. In order to diagnose these cases more accurately, criteria for evaluating the patient are presented.