Nitefor L. Breast sarcoma: optimization of diagnosis and treatment of patients

The dissertation is devoted to the actual problem of oncology – improvement of diagnostics and treatment of patients with breast sarcoma (BS). The basis of the work is retrospective analysis of the results of diagnosis and treatment of patients with BS according to the data of 15 regional oncologic dispensaries of Ukraine and immunohistochemical studies of biopsy material. Significant dissociation of the incidence of BS in different regions of Ukraine (0.01 – 1.94 cases per 100 thousand women) was revealed and the prevalence of certain histotypes in certain areas, due to both the imperfect record and the presence of a subjective factor in diagnosis. It is confirmed that radical operations play a major role in treating patients with sarcoma of the breast; radical surgery should be carried out according to the principles of treatment of soft tissue sarcoma, taking into account the anatomical features of the breast. In the absence of metastatic lymph nodes, a sufficient volume of surgery is a simple mastectomy or wide local resection of the breast. Breast conservative surgery can be performed in the event of a sufficient correlation between the size of the tumor and the volume of the breast. Regional lymph node dissection is appropriate only when the metastatic lymph nodes are morphologically confirmed before the operation. It is inappropriate to carry out prophylactic irradiation of regional lymph nodes (at N0) in patients with BS. The overall five-year survival rate for patients with BS is 61.4 % (95 % CI: 48.43 % – 72.94 %) for surgical treatment, while combined (surgical + radiation therapy) -– 58.6 % (95 % CI: 40.74 % – 74.49 %); in the group of complex treatment (surgical + radiation therapy + polychemotherapy) – 47.8 % (95 % CI: 36.47 % – 59.41 %); in the group of combined treatment, including polychemotherapy – 29.4 % (95 % CI: 13.28 % – 53.13 %). Independent adjuvant methods of chemo-radiation therapy in patients with BS do not achieve the results of surgical treatment. The overall five-year survival rate is 18.9 % (95 % CI: 10.59 % – 31.36 %), which is significantly less than in surgical treatment groups. It has been established that immunohistochemical (IHC) studies play a fundamental role in the differential diagnosis and determination of histotype of BS and the establishment of a morphological variant of a phyllodes tumor. With angiosarcomas, diagnosis of BS in 37.0 % of cases establishes the false positive results of the histological examination. On the basis of the received diagnostic algorithm, which includes the necessary immunohistochemistry markers as the base panel for an IHC study, both in the case of BS and in malignant phyllodes tumor, is proposed. Clinical and morpho-immunohistochemistry diagnosis provides an opportunity to adjust antitumor treatment, to carry out effective clinical monitoring, to evaluate the prognosis of the disease and to make correct encoding in the cancer registry.