BREAST CONSERVING THERAPY IN STAGE T1 ＆ T2 BREAST CANCER PATIENTS

Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.     

乳腺原发性恶性淋巴瘤：附9例报告

本文报告9例经病理证实的乳腺原发性恶性淋巴瘤,占同期乳腺恶性肿瘤0.55％。9例中肿块切除3例次,全乳腺切除5例次,根治术3例次。8例化疗,其中1例辅助放疗。随访率88.9％(8/9)。5年生存率33.3％(2/6)。本组病例特点:年轻患者较多,且恶性程度高;双侧乳腺发病率高;肿块多为非浸润性且生长迅速;皮肤肌肉、腋淋巴结受累少,较早出现全身播散。预后明显较乳腺癌差。作者认为根治术加化疗的疗效相对较好。     

乳头湿疹样癌的诊断与治疗(附27例病例分析)

目的 探讨乳头湿疹样癌的临床表现、诊断、治疗及影响预后的因素。方法 回顾性总结1987年10月～2000年12月西安交通大学第一医院收治的27例乳头湿疹样癌病人的临床资料。结果 乳头湿疹样癌主要以乳头、乳晕区湿疹样病变及乳房肿块为首发症状。伴有乳房肿块的5年及10年生存率(53．7％，39．6％)显低于不伴有肿块的病人的5年及10年生存率(100％，88．1％)(P＜0．05)。结论 对于对症处理2周效果不佳的乳头、乳晕区湿疹样变应尽早行病灶刮片或切取活检，以明确诊断。合并有乳腺肿块的乳头湿疹样癌的首选术式为乳腺癌改良根治术或根治术。     

Tumescent technique versus electrocautery mastectomy: A randomized controlled trial

BackgroundBreast cancer is the most common cancer in Danish women. In 2016 about 1450 (31%) Danish breast cancer patients had a mastectomy.The aim was to compare the frequency of postoperative complications in two methods of surgery, electrocautery dissection and tumescent technique, when performing a mastectomy.MethodsOpen randomized controlled trial of all consecutive primary breast cancer or DCIS female patients who underwent either a simple mastectomy or a modified radical mastectomy in Vejle Hospital, from January 2012 to October 2017.Primary outcomes were seroma production, bleeding, infection and necrosis.Secondary outcomes were duration of surgery and delay of adjuvant treatment caused by complications.Categorical outcome variables were compared between randomization groups using chi-square of Fisher exact test and continuous outcome variables by using Wilcoxon rank test. All analyses were performed at a 5% two-sided significance level.Results357 patients met the inclusion criteria. 14 had bilateral mastectomy, i.e. 371 breasts. The two randomization groups consisted of 105 patients/107 breasts operated by tumescent technique and 98 patients/102 breasts operated by electrocautery technique.Tumescent technique produced more seroma though not significant (p = 0.631) (mean 605 vs. 630 ml). Bleeding in the tumescent group was 10.3% vs. 5.9% in the electrocautery group (p = 0.245).Infection (5.9% vs. 7.5% p = 0.645) and necrosis (4.9% vs. 4.7% p = 0.938) was uncommon with no difference between the intervention groups.Infection was most common cause of delay of adjuvant treatment; 3.9% in the electrocautery technique group.No significant difference in duration of surgery (p = 0.392).ConclusionBoth techniques are equally safe for simple and modified radical mastectomy.     

Epidemiology and management of breast carcinoma in Egyptian males: Experience of a single Cancer Institute

ObjectiveTo assess the epidemiological and clinico-pathological features, surgical and reconstructive techniques, adjuvant treatments and clinical outcome of breast carcinoma in males (BCM) at the Egyptian National Cancer Institute (NCI).Patients and methodsThirty-two males with breast carcinoma presented to NCI between January 2000 and December 2002. They were evaluated by complete history, physical examination, laboratory and radiological investigations.ResultsMedian age was 59 years. Left sided and retroareolar breast lumps were the commonest presentations. Grade II tumors positive for hormone receptors were very common. Stages I, II, III and IV of the disease were encountered in 6.2%, 34.4%, 34.4% and 25.0% of patients, respectively. Curative surgery was done in 22 patients; they received adjuvant hormonal therapy, chemotherapy and radiotherapy in 22, 16 and 10 patients, respectively. Eight metastatic patients were treated with palliative measures. Surgery was done in 25 patients; the most common procedure was modified radical mastectomy (40.6%). Primary closure was feasible in 17 patients (68%), local flaps were needed in 4 cases (16%), while myocutaneous flap was done in 3 cases (12%). The commonest complication was the development of seroma (9 cases). The overall survival (OS) at 5 years was 65.4%. The disease free survival (DFS) at 5 years was 53.9%. Stage and curative surgery significantly affected OS, while type of surgery was the only variable significantly affecting DFS.ConclusionMale breast carcinoma occurs at older ages than females, usually in advanced stage. This necessitates directing attention of males and awareness on the prevalence and risk factors for this disease.     

男性乳腺癌的诊断与治疗

目的探讨男性乳腺癌的诊断与治疗方法。方法回顾性总结男性乳腺癌３２例,中位年龄５４岁。分析了男性乳腺癌的诊断、治疗及预后。结果临床Ⅰ期７例,Ⅱ期１７例,Ⅲ期７例,Ⅳ期１例。３２例患者中,３１例有乳腺肿块。腋窝淋巴结转移率５７．１％。总５年生存率６５．６％,根治术与改良根治术后患者５年生存率分别为６８．４％及６６．７％,非根治术患者５年生存率为５７．１％。结论对于确诊为乳腺癌患者首选改良根治术根据患者不同情况辅以放射治疗、化疗或内分泌治疗     

Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice

Two hundred eight cases of intraductal breast carcinoma (DCIS) were selectively treated; 97 with mastectomy, 96 with radiation therapy, and 15 using excisional biopsy only. Mastectomy patients tended to have larger tumors, involved biopsy margins, palpable and often multifocal tumors. Breast preservation patients tended to have smaller, often occult, tumors with clear surgical margins. Before 1983, mastectomy was more common; during and after 1983, breast preservation was more common. Comedocarcinomas were the most frequent tumors. They were the largest, had the highest percentage of microinvasion (20%), and had the highest recurrence rate (8%). Noncomedo DCIS had a recurrence rate of 1%, one of 103 tumors. The recurrence rate for comedocarcinomas treated with radiation therapy was nearly three times higher than for those treated with mastectomy (11% versus 4%). One of 164 (0.6%) axillary lymph node dissections yielded positive nodes. Nine patients have recurred: two in the mastectomy group and seven in the breast conservation group (P less than 0.1). Eight of nine recurrences were the comedo subtype (P less than 0.05). Three patients developed metastatic disease, two of whom have died. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for most cases. It should be reserved for lesions revealing microinvasion. Conservative therapy for comedocarcinoma must be viewed with caution.     

Usefulness of Magnetic Resonance in Patients With Invasive Cancer Eligible for Breast Conservation: A Comparative Study

BackgroundThe role of magnetic resonance imaging (MRI) in newly detected breast cancer remains controversial. We investigated the impact of preoperative MRI on surgical management of infiltrating breast carcinoma (IBC).MethodsWe reviewed data of 237 patients with IBC who were suitable for breast-conserving surgery (BCS) between 2009 and 2011. Of these patients, 109 underwent preoperative MRI (46%; MRI group) and 128 did not (54%; no-MRI group). We analyzed MRI-triggered changes in surgical plan and compared differences in rates of positive margins and mastectomy.ResultsTumor size was larger in the MRI group (16.8 mm vs. 13.9 mm; P < .001). MRI changed the initial surgical planning in 18 of 109 patients (16.5%) because of detection of larger tumor diameter requiring wider resection (8 patients [7.3%]) or additional malignant lesions in the ipsilateral (9 patients [8.2%]) or contralateral breast (1 patient [0.9%]). MRI-triggered treatment changes included mastectomy (n = 12), wider excision (n = 5), and contralateral BCS (n = 1). Reoperation rates for positive margins after BCS appeared higher in the no-MRI group (4.1% vs. 8.6%), but the difference missed statistical significance (P = .9). Overall mastectomy rates were higher in the MRI group (13.7% vs. 7.0%; P < .05). The likelihood of having a change of treatment resulting from MRI was significantly higher for patients with tumors > 15 mm and for those with positive lymph nodes.ConclusionLymph node positivity and tumor size > 15 mm may predict an MRI-triggered change in surgical plan. Preoperative MRI resulted in higher mastectomy rates justified by biopsy-proven additional foci of carcinoma and did not significantly reduce reoperation rates for positive margins.     

Radical mastectomy for operable breast cancer

The experience with radical mastectomy in the treatment of 152 cases of operable breast cancer at the Hadassah University Hospital has been analyzed. An overall 5 year survival of 75% and a 10 year survival of 62% are reported and compared with results from other methods of treatment. Based on the excellent survival rates achieved and the low incidence of local recurrence (9.8%), the present study suggests that radical mastectomy is still the most suitable surgical procedure in the treatment of operable breast cancer.     

Identification of breast tumors from diathermy smoke by differential ion mobility spectrometry

IntroductionBreast cancer is the most frequent cancer in women worldwide. The primary treatment is breast-conserving surgery or mastectomy with an adequate clearance margin. Diathermy blade is used extensively in breast-conserving surgery. Surgical smoke produced as a side product has cancer-specific molecular features. Differential mobility spectrometry (DMS) is a rapid and affordable technology for analysis of complex gas mixtures. In our study we examined surgical smoke from malignant and benign breast tissue created with a diathermy blade using DMS.Material and methodsPunch biopsies of 4 mm diameter from breast cancer surgical specimens were taken during gross dissection of fresh surgical specimen and placed in a well plate. The measurement system is a custom-built device called automatic tissue analysis system (ATAS) based on a DMS sensor. Each specimen was incised with a diathermy blade and the surgical smoke was analyzed.ResultsWe examined 106 carcinoma samples from 21 malignant breast tumors. Benign samples (n = 198) included macroscopically normal mammary gland (n = 82), adipose tissue (n = 88) and vascular tissue (n = 28). The classification accuracy when comparing malignant samples to all benign samples was 87%. The sensitivity was 80% and the specificity was 90%. The classification accuracy of carcinomas to ductal and lobular was 94%, 47%, respectively.ConclusionsBenign and malignant breast tissue can be identified with ATAS. These results lay foundation for intraoperative margin assessment with DMS from surgical smoke.     

Surgical treatment of phyllodes tumors of the breast

Eighty-one female patients with phyllodes tumors of the breast, surgically treated from 1974 to 1983, were studied. Their age ranged from 9 to 88 years. According to histology, the series was divided into three groups, of 28 (34.5%) benign tumors, 32 (39.5%) border-line tumors, and 21 (25.9%) malignant tumors. Because ten patients were lost to follow-up, only 71 women could be evaluated. All the patients had received surgical treatment: 51 women had been treated conservatively (11 enucleations, 40 wide resections), and 20 had undergone radical operations (13 underwent total and five underwent subcutaneous mastectomies, whereas one underwent modified and one underwent radical mastectomy). The mean follow-up, for the three groups, was 106 months for benign, 84 months for borderline, and 82 months for malignant tumors; in no case was radical surgery followed by local recurrence: of 51 women conservatively treated, 14 experienced local relapse, i.e., one of 24 women with benign, ten of 22 with borderline, and three of 8 with malignant lesions. Only two of 47 patients (4.2%) with borderline or malignant tumors developed distant metastasis and died from disease. No relationship between tumor size and risk of local recurrence could be demonstrated, and no difference could be identified between borderline and malignant lesions, in terms both of local and distant relapse. Local recurrences do not appear to affect survival: as a consequence, wide resection should be the primary treatment. Enucleation is to be proscribed. Total mastectomy has been indicated for very large tumors and for local recurrences of borderline and malignant lesions. Axillary dissection is not worthwhile.     

Primary breast lymphomas--a retrospective analysis of twelve cases

This study was undertaken to define the natural history and treatment results of patients with primary breast non-Hodgkin's lymphoma (NHL). Twelve female patients who had been followed at Hacettepe University Hospital between 1973 and 1997 were retrospectively evaluated. All patients presented with breast masses (6 in the right breast and 6 in the left) that had recently enlarged. The most common histologic subtype was diffuse, small cleaved-cell lymphoma. Chemotherapy regimens were employed in 9 patients. Radiotherapy was delivered to the breast and its lymphatics in 8 patients. Lumpectomy, simple or modified radical mastectomy was performed in 5 cases. An objective response was attained with surgery, chemotherapy, or radiotherapy alone in 2, 1, and 1 cases, respectively. Combined modality treatment including either two or three modalities was successful in 7 cases. The median progression-free and overall survival times were 49 and 56 months, respectively. Although primary NHL of the breast is a rare disease compared to carcinoma, it should be considered in the differential diagnosis of breast masses.     

Male Breast Cancer: a 24 Year Experience of a Tertiary Care Hospital in Pakistan

Background: Male breast cancer accounts for less than 1% of all cancers found in men. It usually presentsat a later age and stage as compared to female breast cancer. Treatment strategies are extrapolated from themanagement of female breast cancer. Our study here looked at 18 patients diagnosed with and treated for malebreast cancer at The Aga Khan University Hospital in Pakistan. We compared our findings with the existingdata from Asian and Western countries. Materials and Methods: A retrospective study was conducted looking atpatients with male breast cancer between January 1986 and December 2009. Patient and disease characteristicswere analyzed and 5 year overall survival was calculated using Microsoft Excel and SPSS. Results: The averageage at diagnosis was 52 years (38-67 years). Twelve (66.7%) patients had axillary lymphadenopathy. Stage IIdisease was the most common stage at presentation (9 patients, 50%). Infiltrating ductal carcinoma was seen in16 patients (88.8%). Seven lesions were positive for both estrogen and progesterone receptors. Sixteen patientshad surgery in the form of either modified radical mastectomy or radical mastectomy. Radiation was used in7 patients in an adjuvant setting. The five year overall survival for stage I, II, III and IV disease was 100% vs78% vs 50% vs 0%( p<0.05). Five year overall survival was 61%. None of the other prognostic factors werestatistically significant. Median follow up was 15 months (3-202 months). Conclusions: Male breast cancer maybe on a slow rise but is still an uncommon disease. Tumor stage and lymph node status are important prognosticmarkers. Public awareness and screening may help in detecting the disease at an earlier stage. Prospective trialsare needed to improve the management of this disease.     

Metastases to the breast: differential diagnosis from primary breast carcinoma

Eight patients with breast metastases from primary tumors other than breast carcinoma were studied: 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 appendiceal carcinoid, and 1 epidermoid cervical carcinoma. All had mammographic, histopathologic, and immunohistochemical examinations. The main problem was differential diagnosis from primary breast carcinoma. History of extramammary primary tumor was helpful but breast metastasis was the first clinical feature in 2 cases. Patients had noticed palpable, round, rapid growth masses which were mammographically benign. Pathologic diagnosis was difficult and immunohistochemical studies necessary, whenever the proliferation had histologic features of primary breast carcinoma or when no primary tumor was known. However, some histologic features were of value for diagnosis of metastasis: atypical histologic features for a primary breast carcinoma, a well-circumscribed tumor with multiple satellite foci, the absence of an intraductal component, and the presence of many lymphatic emboli. In adults, the most frequent types of tumors metastasizing in the breast are malignant melanoma and neuroendocrine-like tumors, especially small cell carcinoma and carcinoid. In children, rhabdomyosarcoma is the most common. Accurate diagnosis of breast metastasis is important to avoid unnecessary mastectomy and to implement an appropriate systemic therapy.     

乳腺纯上皮化生性癌9例观察及文献复习

背景与目的:乳腺化生性癌十分少见。对此,本文旨在探讨乳腺纯上皮化生性癌的病理和临床特征以及治疗。方法:回顾性分析1997-2007年9例在我院治疗的女性乳腺纯上皮化生性癌病例。结果:患者中位年龄50岁(37～78岁),9例均行根治术或改良根治术,病理诊断为梭形细胞化生性癌6例,鳞癌3例。雌激素受体(ER)和/或孕激素受体(PR)阳性者2例。2例淋巴结转移。中位随访时间为25(3～112)个月,术后局部复发1例,远处转移3例,肺转移2例,2例患者死亡,1例带瘤生存。结论:本病以梭形细胞化生性癌多见,可同时表达上皮和间叶组织抗原,但较少表达ER和PR。患者多以无痛性肿块就诊,肿块局切复发率高。腋窝淋巴结转移少见,肺转移多见。手术治疗宜选择单纯乳房切除加前哨淋巴结活检。     

Significance of the relative size of a breast tumor in deciding the method of surgical treatment

AIM: In the surgical treatment of breast cancer there are basically two options: radical and breast-sparing surgery. The main criterion in deciding the mode of treatment is the absolute size of the primary tumor. The purpose of this study was to analyze the relative size of a breast tumor as a prognostic factor and to establish boundary values of the relative tumor size for breast-sparing or radical surgery. METHODS: The relative volume of the breast tumor was analyzed in 200 female patients treated at the Zagreb University Hospital for Tumors. All patients were diagnosed with ductal invasive carcinoma and underwent radical surgery. RESULTS: The study found the correlation between the relative volume of the tumor and tumor grade (r = 0.805, P = 0.24) and between the relative volume of the tumor and the involvement of regional lymph nodes (r = 0.493, P = 0.14). These correlations confirmed the possible prognostic value of the relative size of a breast tumor. CONCLUSIONS: Three percent is the boundary value of the relative volume of a tumor at which its biological potential changes and the pathohistological level of a tumor and the number of affected lymph nodes increases. The relative size of 3% could therefore be considered a boundary value in making a decision about the method of surgical treatment (breast-sparing or radical surgery). For tumors with a relative size of less than 3%, breast-conserving surgery is recommended for its lesser malignant potential and the possibility of performing wide extirpation (extirpation 1-2 cm from the tumor margin), regardless of the size of the breast.     

Localized Therapy for Male Breast Cancer: Functional Advantages With Comparable Outcomes Using Breast Conservation

BackgroundMale breast cancer (MBC) accounts for approximately 1% of all breast cancers. Given the rarity of this disease, treatment of MBC generally follows the same principles as treatment of female breast cancer. However, the traditional surgical approach for MBC is modified radical mastectomy (MRM) or total simple mastectomy (TSM) instead of breast conservation surgery (BCS). The purpose of this study was to examine the feasibility of BCS as an alternative to mastectomy for MBC with respect to musculoskeletal functionality and treatment outcome.Patients and MethodsA retrospective analysis was undertaken of all male patients with breast cancer who presented to Massachusetts General Hospital or Boston Medical Center for localized therapy from 1990 to 2003. Musculoskeletal functionality (tissue fibrosis, arm edema, and range of motion) and treatment outcome (local-regional control, disease-free survival, and overall survival) were evaluated. Functional/cosmetic outcomes were assessed by multidisciplinary review of patient follow-up visits and were scored as either “good-excellent” or “fair-poor” to account for subjectivity between different clinicians.ResultsForty-two patients in total were identified to undergo localized treatment. Thirty patients (71%) received MRM, 4 (10%) had TSM, and 8 (19%) underwent BCS. Actuarial overall 1-year fair-poor documented tissue fibrosis, arm edema, and decreased range of motion rates were 13%, 23%, and 27% for patients receiving MRM; 25%, 0%, and 50% for patients who underwent TSM; and 13%, 0%, and 0% for those undergoing BCS, respectively. Overall survival and disease-free survival were not statistically different between the groups.ConclusionsThese data suggest that breast conservation therapy may be considered a reasonable local treatment option for male patients presenting with breast cancer because it may offer functional advantages over mastectomy with comparable rates of local control and disease-free survival and overall survival.     

A Clinical Database of Breast Cancer Patients Reveals Distinctive Clinico-pathological Characteristics: a Study From Central China

Background: Breast cancer is the most common malignant tumor in females worldwide. Many differencesexist in clinico-pathological characteristics of breast cancer patients between China and Western countries. Thisstudy aimed to analyze clinico-pathological characteristics of breast cancer from central China. Methods: Clinicopathologicalinformation on breast cancer from three hospitals in central China was collected and analyzed.Results: From 1994 to 2012, 2,525 patients with a median age 50 years were included in this study. The 45-49-yearage group and invasive ductal carcinoma not otherwise specified accounted for the highest proportions (19.1%,480/2,525 and 81.0%, 1,982/2,446). Stages 0-I, II and III accounted for 28.0% (682/2,441), 48.4% (1,180/2,441),and 23.7% (578/2,441), respectively. Distribution of N stage showed that N0 accounted for 53.2% (1,344/2,525),and proportion of N0 rose from 51.1% (157/307) in 30-39-year age group to 64.3% (110/171) in ≥ 70-year agegroup, with an average increase of 2.1% in each age group. Modified radical mastectomy, radical mastectomy,breast-conserving surgery and simple mastectomy were performed for 71.8% (1,812/2,525), 18.0% (454/2,525),5.2% (131/2,525) and 2.6% (66/2,525), respectively. Proportions of breast-conserving surgery in age ≤ 44-yeargroup (68/132, 51.5%) and simple mastectomy in age ≥ 60-year group (57/89, 64.0%) were higher than in the otherage groups. Breast cancers positive for estrogen receptor accounted for 53.0% (1,107/ 2,112). The comparisonsamong this study and other reports showed higher proportion of younger patients, lower proportion of breastconservingsurgery and positive estrogen receptor patients in China than western countries. Conclusions:Clinico-pathological characteristics in this study demonstrated clear differences between the center of Chinathan Western countries. Additional classification systems should be developed to guide grading of early breastcancer more accurately, especially for N0 patients. Invasive ductal carcinoma is a focus for intensive research.     

Prise en charge des tumeurs phyllodes malignes du sein : l’expérience de l’institut Curie

PurposeGiven the scarcity of malignant phyllode tumours of the breast and the absence of consensus regarding their management justify the need for institutional retrospective evaluations of clinical practices.Patients and methodsRetrospective study with central pathology review of the 25 consecutive patients treated at the Institut Curie (Paris, France) between 1969 and 2006 for non metastatic malignant phyllodes tumors of the breast. The median follow-up was 65 months (7–257 months).ResultsMedian age at diagnosis was 52 years (20–64 years). Breast surgery was conservative in five patients (20%). Surgical margins were wide (> 10 mm), narrow, involved or unknown in respectively 17 (68%), three (12%), three (12%) and two (8%) patients. Median tumour size was 65 mm (12–250 mm). Adjuvant radiotherapy was delivered in seven (28%) patients (two patients, posttumorectomy; five patients, postmastectomy) and 13 patients (52%) received anthracycline-based adjuvant chemotherapy. Five-year overall survival rate was 91% (95% CI, 80–100%). Five patients (20%) developed distant metastases (one after chemotherapy) and three (12%) locoregional relapse (one after tumorectomy and unknown margin without radiotherapy, two after mastectomy and involved margins with radiotherapy).ConclusionWide breast surgery (that can be conservative in selected patients) is the mainstay of the treatment of non metastatic malignant phyllodes tumors of the breast. To better determine the respective roles of adjuvant systemic treatment and radiotherapy, further clinical studies and the search for new prognostic and predictive factors remain necessary.     

Soft tissue angiosarcomas

From 1949 to 1979, 12 patients with soft tissue angiosarcoma received radiotherapy (alone or in combination with other modalities of treatment) with curative intent at The University of Texas M.D. Anderson Hospital and Tumor Institute. The primary site was the head and neck in six patients (scalp, four; maxillary antrum, one; and oral tongue, one), the breast in four patients, and the thigh in two patients. All four patients with angiosarcoma of the scalp had advanced multifocal tumors, and two of them had clinically positive neck nodes. None of these tumors were controlled locally, and local recurrences occurred within and/or at a distance from the generous fields of irradiation. The remaining two patients with head and neck lesions had their disease controlled by surgery and postoperative irradiation. Three of the four angiosarcomas of the breast were primary cases which were treated by a combination of surgery (excisional biopsy, simple mastectomy, radical mastectomy) and postoperative irradiation. One patient also received adjuvant chemotherapy. The fourth patient was treated for scar recurrence after radical mastectomy. All four patients had their disease locally controlled, and two of them have survived over 5 years. The two patients with angiosarcoma of the thigh were treated by conservative surgical excision and postoperative irradiation. One patient had her disease controlled; the other had a local recurrence requiring hip disarticulation and subsequent hemipelvectomy for salvage.