Treatment
There is no general and comprehensive consensus on the management of
PBOS. Some consider it as a sarcoma and emphasized that the management
of PBOS should be similar to that of other sarcomas(20,37); whereas, some others believe that it should
be treated like triple-negative epithelial carcinomas(1). The value and effectiveness of chemotherapy have
been emphasized, particularly with the tumor size more than 5 cm(38,39,40); however, there are still some reports that
they did not offer chemotherapy to/for their patients(22,31) even with the tumor size of 6 cm(41). Although Axillary Lymph Node Dissection (ALND)
or sentinel lymph node biopsy has been performed in some reports
(18,22,23,40,42,43) in most of the reports ALND was not performed for
the patients (2,3,4,24,44,45). Similar to
chemotherapy, considering irradiation as a part of treatment is not
widely accepted at least as far as the tumor size is not large enough
and the margins are clear from tumoral deposits(4,31,38); however, chest wall irradiation has been
suggested by some other authors to reduce the risk of local recurrence
as a routine part of treatment (46). It seems that
achieving a negative margin either with wide local excision or simple
mastectomy without ALND is widely accepted/adapted and offering
chemotherapy and radiotherapy should be based on prognostic factors of
each patient. It is worth mentioning that due to the local recurrence
and distant metastasis rate of about 40% within the first year(2,47), an aggressive approach including appropriate
surgery and adjuvant therapy should be considered while administration
of chemotherapy or radiotherapy must be balanced against the
consequences of these treatments per case.