Radiation-induced angiosarcoma of the breast: a retrospective analysis of 15 years' experience at an oncology center

Abstract

ObjectiveTo characterize a population of patients with radiation-induced angiosarcoma (RIAS) of the breast treated at an oncology center, focusing mainly on the imaging features, although also on the clinical presentation, diagnosis, and management.Materials and MethodsWe performed a retrospective review of patients with histologically proven angiosarcoma of the breast or chest wall, all of whom received radiotherapy, after conservative or radical breast surgery, between 2000 and 2015.ResultsEleven patients met the inclusion criteria. The median age at the time of diagnosis of RIAS of the breast was 71.5 years (range, 58-87 years), and the median latency period was 8.9 years (range, 4-27 years). The rate of local recurrence was 54.4%, RIAS recurring after a median period of 10 months (range, 3-18 months), and distant metastases occurred in three patients (27.3%). All of the tumors were accompanied by skin changes, and a palpable mass was seen in four. Most of the imaging findings were nonspecific. Six patients underwent magnetic resonance imaging, which revealed pronounced skin enhancement in all six. Ultrasound-guided core needle biopsies were negative in three of the eight patients.ConclusionRIAS of the breast is a rare but recognized complication of radiotherapy for breast carcinoma, with a poor prognosis and high recurrence rate, which requires a high index of suspicion for a prompt diagnosis.

Clinical Outcomes for Primary and Radiation-Associated Angiosarcoma of the Breast with Multimodal Treatment: Long-Term Survival Is Achievable

“…Primary angiosarcoma of the breast (PAS) and radiation-associated angiosarcoma of the breast (RAAS) are rare sarcomas that affect the inner lining of blood vessels in the breast with incidences of 0.05% and 0.02%, respectively [1][2][3]. Moreover, given the aggressive nature of these sarcomas, locoregional recurrence rates (53% for PAS and 46% for RAAS) and distant metastasis (34% for PAS and 13% for RAAS) remain high, leading to poor median overall survival (OS) rates at 16 months for PAS and 12 months for RAAS following either surgery or chemotherapy alone [2,[4][5][6][7][8]. As a result of low incidence and poor outcomes, optimal treatment guidelines remain limited.…”

Radiation-induced angiosarcoma: case report

“…(5,6) However, RASB has a high local recurrence rate and metastasis is more common to the lungs and liver, occurring simultaneously or soon after local recurrences. (7) Clinical manifestations of RASB are frequently described as small, violaceous skin lesions, which resemble telangiectasia. Nevertheless, nodules, plaques or patches may also appear.…”

“…However, RASB has a high local recurrence rate and metastasis is more common to the lungs and liver, occurring simultaneously or soon after local recurrences. ( 7 )…”

“…Porém, o AMRO apresenta alta taxa local de recidiva e metástase, sendo mais comum nos pulmões e no fígado, ocorrendo simultaneamente ou logo após as recorrências locais. ( 7 )…”

Nothing is impossible: radiation induced angiosarcoma of breast in a male patient

“…RIAS is relatively rare, with an estimated incidence at between 0.05 and 0.3% in women treated with radiotherapy. It is a well recognized late complication of adjuvant radiotherapy, with a latency period that varies from approximately five to ten years [6].…”