Lymphangiosarcoma in postmastectomy lymphedema: five-year survival with irradiation treatment

A Case of Postmastectomy Lymphangiosarcoma

A case of postmastectomy lymphangiosarcoma of the arm, arising 13 years after the operation, is described. A singular character of the case was the absence of lymphedema in the affected arm.

Lymphangiosarcoma: Is Stewart-Treves Syndrome a Preventable Condition?

BACKGROUND

Stewart-Treves syndrome is a rare complication of breast cancer treatment, representing a lymphangiosarcoma commonly associated with lymphedema and severely impacting patient's outcome. The tumor typically develops in the atrophic, pachydermatous, hyperkeratotic skin of limbs affected by long-standing lymphedema. Clinical data associated with Stewart-Treves syndrome and lymphedema management have rarely been published.

METHODS AND RESULTS

In the period between 1980 and 2009, ten patients with Stewart-Treves syndrome were diagnosed and treated at the Foeldiklinik, Hinterzarten, Germany. Nine of the ten patients were female. Five patients had previously suffered from breast cancer (and were treated with mastectomy); two from other malignancies; two patients had primary lymphedema, and one had undergone lower extremity lymphadenectomy. All cancer patients had undergone radiation treatment. In all cases, the sarcoma developed in non-irradiated areas 6-48 years (average 16.3 years) after the onset of lymphedema. None of the patients had received complex decongestive physical therapy (CDT). Two patients had above-elbow amputation, one had shoulder exarticulation, two patients had wide excision and skin grafting, two patients had above-knee amputation procedure, two patients had a below-knee amputation procedure, and one patient had no surgical treatment at all. The time to recurrence after surgery, time to metastasis, patient survival and CDT were recorded.

CONCLUSIONS

Patients with lymphedema should be closely examined starting 5 years from the time of lymphedema onset, paying special attention to those with associated malignancies. Only early diagnosis and treatment by radical ablative surgery confers a reasonable prognosis with this rare but aggressive disease. A potential effect of CDT on lymphangiosarcoma has to be studied in a greater patient cohort.

Role of surgery in the management of postmastectomy extremity angiosarcoma (Stewart-Treves syndrome)

Stewart-Treves syndrome (STS) is the rare occurrence of angiosarcoma in a setting of postmastectomy upper extremity lymphedema. A collective comparison of outcomes following various initial treatment options in STS has not previously been reported. We reviewed 160 cases of STS reported in the literature since 1966. We analyzed the relationship between initial treatment and survival in all 92 of these patients for whom detailed treatment and outcome data had been reported. There was no significant difference in survival comparing those initially treated with wide excision (n = 16) and those treated with amputation (n = 45) (P = 0.40). Even in the setting of initial surgical treatment, overall long-term survival was poor (<40%). There have been even fewer long-term survivors among those treated initially with regional chemotherapy (n = 7) or radiation therapy (n = 24). An update on STS and a discussion of recent advances in the understanding of its molecular pathogenesis that may result in future treatment improvements are presented.

Lymphedema of the upper limb after surgery for breast cancer

Radical mastectomy is followed by swelling of the arm, and although the number of surgeons employing the operation is decreasing, postmastectomy lymphedema continues to be a serious complication. In the present report based on 158 women who underwent modified radical (126) or simple (32) mastectomy and occasionally radiation for histologically proved adenocarcinoma of the breast, the pathogenesis and treatment of postmastectomy lymphedema are discussed. The following conclusions can be drawn: (1) The occurrence of postmastectomy lymphedema diminishes the less extensive the operation. (2) Mild lymphedema that develops early postoperatively tends to subside. (3) Conservative treatment in the majority of cases is effective in controlling postmastectomy lymphedema of a mild to moderate degree. (4) Modified radical mastectomy, which is as radical as Halsted's operation, is rarely followed by lymphedema.

Postmastectomy lymphangiosarcoma-temporary response to cyclophosphamide chemotherapy in 2 cases

Two cases of lymphangiosarcoma developing in oedematous arms following radical mastectomy (Stewart-Treeves syndrome) are reported. Both patients showed marked symptomatic improvement and tumour regression on cyclophosphamide therapy although remission was only temporary.

Lymphangiosarcoma following post-mastectomy lymphedema

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Lymphangiosarcoma following post-mastectomy lymphoedema

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