Radiotherapy for Myeloid Sarcoma of the Breast: A Case Report and Review of the Literature

Case Report

Ann Hematol Onco. 2023; 10(3): 1425.

Radiotherapy for Myeloid Sarcoma of the Breast: A Case Report and Review of the Literature

Dortmans J*; Zissiadis Y

Department of Radiation Oncology, Genesis Care, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch WA 6150 Australia

*Corresponding author: Dortmans J Department of Radiation Oncology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch WA 6150, Australia. Tel: (+61) 86152 2222 Email: [email protected]

Received: April 20, 2023 Accepted: May 15, 2023 Published: May 22, 2023


While the role of systemic therapy in the treatment of myeloid sarcoma is well documented, the evidence for the use of radiation therapy is sparse. We present a case of isolated myeloid sarcoma to the breast. Following treatment for myelodysplastic syndrome. Myeloid Sarcomas (MS) are also known as chloromas and granulocytic sarcomas. They are extramedullary tumours of immature myeloid cells that develop in the setting of Acute Myeloid Leukaemia (AML), Chronic Myeloid Leukaemia (CML) and accelerated phase MyeloDysplastic Syndrome (MDS) [1]. Treatment options include systemic therapy, localised radiation treatment or surgery. Retrospective series have identified that radiotherapy provides safe and reliable local control and symptom palliation [2]. We conducted a review of literature to assess the rationale, role, and dose of radiotherapy for this rare leukemia manifestation in the breast.

Keywords: Myeloid sarcoma; Chloroma; Granulocytic sarcoma; Breast; Radiotherapy


A literature search was performed in MEDLINE and Pubmed for articles on myeloid sarcoma to the breast published between 1972 and August, 2020 using the following keywords and phrases: myeloid sarcoma, chloroma, granulocytic sarcoma, extramedullary sarcoma, breast, radiotherapy, radiation therapy. Additional evaluated articles were identified by back referencing from bibliographies of original articles. The search was limited to English language articles.

Case Presentation

We present a case of a 52-year-old woman with myeloid sarcoma of the left breast and axillary nodes following allogenic matched unrelated bone marrow transplant for Myelodysplastic Syndrome (MDS) two years prior.

This patient was initially diagnosed with MDS, treated with azacitidine followed by matched unrelated bone marrow transplant 10 months following diagnosis.

20 months following her transplant she self-detected a left breast mass, evident on mammogram which confirmed a 28mm dense mass in the upper outer quadrant. Ultrasound showed a 30mm poorly defined mass with heterogenous echotexture, and enlarged left axillary lymph nodes.

Core biopsy of breast lesion showed Myeloid Sarcoma (MS), with mixed phenotype. Bone marrow aspirate and trephine revealed slightly hypercellular marrow with reactive changes, showing no evidence of excess blasts and the chimerism was 99% donor. There was no evidence of systemic relapse. Staging PET scan showed a solitary FDG-avid left breast lesion and two ipsilateral axillary lymph nodes. No abnormal FDG avidity was seen elsewhere to suggest metastases.

Treatment options presented to the patient included systemic therapy, localised radiation treatment or close surveillance. The patient opted to proceed with localised involved field radiation therapy, with the aim of locoregional control and delaying time to systemic therapy, accepting that this treatment approach was unlikely to result in cure.

Radiotherapy was delivered using a Deep Inspiration Breath Hold technique (DIBH) to minimise cardiac dose with a left sided breast malignancy, and utilised IMRT treatment to deliver a dose of 40Gy in 20 fractions over 4 weeks. The treatment volume included the entire left breast, and left axilla. Coverage of >95% was achieved for all volumes.

The patient tolerated treatment well, with a good clinical response in both the breast and axilla at completion of treatment.