This article discusses the treatment of adult soft tissue sarcoma (excluding gastrointestinal stromal tumor), analyzing the principles underlying treatment and the results of surgery, radiotherapy, ...and chemotherapy. The focus is on the European approach in particular, and ongoing studies are summarized.
BACKGROUND
Angiosarcoma (AS) accounts for 1 to 2% of all soft tissue sarcoma. Both primary and secondary AS may occur, the latter being reported in the upper extremity with lymphedema after extended ...radical mastectomy for breast cancer (postmastectomy AS) or following radiotherapy of the breast, the thoracic wall, or other sites (radiation‐associated AS). The authors report two cases of cutaneous radiation‐associated AS and review literature regarding treatment planning and follow‐up data to define the most appropriate therapy for cutaneous and noncutaneous radiation‐associated AS.
METHODS
The clinical records of two patients with radiation‐associated AS were analyzed and previously reported cases were reviewed.
RESULTS
Case 1: a female age 67 years developed cutaneous AS in the residual breast 27 months after breast‐conserving therapy and conventional external beam radiotherapy (EBR). She underwent chemotherapy followed by simple mastectomy and chemotherapy with the same regimen but developed early recurrence that was treated with hyperthermia and EBR, wide excision, and second‐line chemotherapy. She died 30 months after primary diagnosis of AS with multiple metastases. Case 2: a male age 59 years developed cutaneous AS in the left groin, 10 years after conservative surgery and EBR for a penile carcinoma. Early recurrence following wide excision was treated with chemotherapy, re‐excision, and immunochemotherapy but the patient died 24 months after the primary diagnosis of cutaneous AS with local progression and distant metastases.
CONCLUSIONS
The prognosis of radiation‐associated AS is dismal, due mostly to its poor differentiation and frequent diagnostic delay. Simple mastectomy is advised for patients with cutaneous AS after breast‐conserving surgery with wide tumor‐free margins. If primary surgery fails, survival is seriously compromised because adjuvant or palliative treatments are not effective. Cancer 1996;77:2496‐502.
IN patients who receive radiotherapy alone for advanced, inoperable squamous-cell carcinoma of the head and neck, the expected five-year survival is lower than 25 percent,
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and in patients with ...local invasive and massive nodal involvement, it may be as low as 1 to 2 percent.
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Chemotherapy has been combined with radiotherapy in an attempt to improve the outcome in such patients. However, adjuvant chemotherapy has had no advantage over standard local therapy alone, even though responsiveness to chemotherapy has proved to be the best predictor of responsiveness to radiotherapy and subsequent survival.
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Comparisons of simultaneous chemotherapy and radiotherapy with radiotherapy . . .
General practitioners (GPs) are in a key position to intervene with patients who smoke. The cornerstone of a smoking cessation strategy should be the routine provision of brief advice and follow-up ...in primary care. However, it seems GPs do not often take action against smoking, at least in Italy as shown by previous reports. The survey was planned, in the context of the "GPs Empowerment Project", a collaborative project involving Denmark, France, Greece, Italy and Portugal, under the ENSP contract with the European Commission (Health & Consumer protection Directorate-General), to evaluate the general attitude, knowledge and behavior of GPs regarding smoking cessation methods.
A total of 729 family doctors, 409 in Northern and 320 in Southern Italy, were interviewed by phone in the period July-October 2000 regarding their personal smoking habits and their approach with patients on the topic. Prevalence rates were computed using the Epi INFO 6.0 software and were presented as the unadjusted percentage prevalence.
The percentage of current smokers among GPs included in the survey was 28.3%, with a higher prevalence in the south (33.3%). Most of the GPs believe that it is their duty to give information about smoking cessation (96.8%) and consider giving information about smoking cessation to their patients an important intervention (98.5%), but only about 49% think their patients will accept their advice. Most GPs (87.3%) declared having discussed about tobacco use with their patients during the month preceding the interview, and 83.5% would like to be trained on smoking cessation strategies.
The results show that, in order to implement primary prevention in clinical practice in Italy, it appears essential to reduce the number of GPs who smoke and to improve GP training on smoking cessation procedures.
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