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Competing Interests: Competing interests: None declared.

Background: Radiation-associated angiosarcoma (RAAS) of the breast is an aggressive malignancy affecting 1 in 1000 breast cancer patients. This study aimed to determine differences in treatments and outcomes for RAAS initially managed through a sarcoma multi-disciplinary team (SMDT) compared with an outside center (OC) and to describe outcomes after recurrence., Methods: Patients with a diagnosis of breast RAAS between 2004 and 2019 were identified from our sarcoma database. Clinicopathologic characteristics, recurrence patterns, and factors predictive of survival were assessed. Differences in local recurrence-free survival (LRFS) and disease-specific survival (DSS) were estimated using Kaplan-Meier and compared using the log-rank test., Results: Surgery was performed for 49 women with RAAS, who had a median age of 74 years (range 41-89 years). Primary management was performed by SMDT for 26 patients and by OC for 23 patients. Radical mastectomy and reconstruction were performed for 96% of the SMDT group versus 17% of the OC group (p = 0.00001). The proportion patients who received chemotherapy, radiation, or both was 42.3% in the SMDT group and 0% in the OC group. During a median follow-up period of 26 months, recurrence was experienced by 38% (10/26) of the SMDT cohort and 83% (19/23) of the OC cohort (p = 0.002). The 3-year LRFS was better in the SMDT cohort (59.3% vs 31.8%; p = 0.019). Of the 29 recurrences 16 received chemotherapy and 6 received radiation, surgery, or both. At the last follow-up visit, 20 patients were in first remission, 1 patient was in second remission, 8 patients were alive with disease, and 20 patients had died of disease., Conclusion: Initial treatment by SMDT was associated with more extensive surgery, multimodal treatments, and a better 3-year LRFS. Patients with breast RAAS likely benefit from early referral and treatment by an SMDT., (© 2021. Society of Surgical Oncology.)

Leiomyosarcomas (LMS) are genetically heterogeneous tumors differentiating along smooth muscle lines. Currently, LMS treatment is not informed by molecular subtyping and is associated with highly variable survival. While disease site continues to dictate clinical management, the contribution of genetic factors to LMS subtype, origins, and timing are unknown. Here we analyze 70 genomes and 130 transcriptomes of LMS, including multiple tumor regions and paired metastases. Molecular profiling highlight the very early origins of LMS. We uncover three specific subtypes of LMS that likely develop from distinct lineages of smooth muscle cells. Of these, dedifferentiated LMS with high immune infiltration and tumors primarily of gynecological origin harbor genomic dystrophin deletions and/or loss of dystrophin expression, acquire the highest burden of genomic mutation, and are associated with worse survival. Homologous recombination defects lead to genome-wide mutational signatures, and a corresponding sensitivity to PARP trappers and other DNA damage response inhibitors, suggesting a promising therapeutic strategy for LMS. Finally, by phylogenetic reconstruction, we present evidence that clones seeding lethal metastases arise decades prior to LMS diagnosis., (© 2021. The Author(s).)

Adolescents' engagement in risk-taking behaviors is well documented. However, the role of the dental practitioner in helping teenage patients understand and avert those behaviors is relatively unknown. The aim of this pilot study was to assess dental students' familiarity with adolescent risk behaviors, comfort level in discussing adolescent risk behaviors with teenage patients, and ratings of the relevance of these topics in dental education. Of the 373 University of Florida dental students across all four years who were invited to participate in 2017, 151 (40.5%) completed the survey. Among these respondents, 66% were female, 53% were from an underrepresented minority (URM) group, 40% were above the age of 25, 53% were in their preclinical years of education, and 47% were in their clinical years. In the results, the males had higher levels of comfort discussing adolescent risk behavior topics than the females, and the non-URM students had higher levels of comfort than the URM students. The clinical students showed statistically significant higher levels of comfort and ratings of the relevance of adolescent risk behaviors than the preclinical students. This pilot study assessed these students' comfort in discussing adolescent risk behaviors with patients and their level of agreement about the relevance of those topics in dental education across groups (age, gender, minority status, and educational level). Future studies are needed to examine pre- and posttest changes following interventions aimed at enhancing students' knowledge and comfort in discussing adolescent risk behaviors.

Competing Interests: Competing interests: None declared.