Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall

Abstract

The present study shows that reRT + HT treatment--either alone or combined with surgery--improves LC rates in patients with RAS.

Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection

“…Concurrent hyperthermia is an effective adjunct to increase radiation sensitivity with randomized clinical data demonstrating promising results for superficial tumors [9]. ETT has been previously employed in AS and a report on its use in 23 patients with concurrent daily radiation demonstrated a complete response rate of 56%, and a three-year local control of 46% for those who also underwent surgery with late grade 4 toxicity in two patients [8]. We have noted modest toxicities with hyperthermia in our clinical practice.…”

“…After accelerated hyperfractionated radiation, the University of Florida has reported complete response in all seven patients who underwent subsequent surgical resection after a high-dose hyperfractionated radiation [7]. In the reported series combining radiation and hyperthermia, one of three patients undergoing a neoadjuvant strategy achieved a pathological complete response [8]. Given that our patient had an intermediate grade tumor, it is possible that with additional time between neoadjuvant therapy and surgery, a complete pathological response may have been appreciated.…”

“…This AS recurred after wide local excision alone, a common occurrence in up to two-thirds of patients undergoing surgery alone [8]. Wide resection does appear to be helpful, as one series of nine patients had only two local failures with planned surgical margin of at least 3 cm, although this is not always possible [4].…”

“…Of these, one promising approach is the use of accelerated hyperfractionated radiation therapy, initially reported by Feigenberg, et al and updated most recently in 2014, using radiation therapy twice daily (BID) and three times daily (TID) [6][7]. An alternative approach undertaken in the Netherlands is the use of external thermal therapy (ETT) concurrent with radiation [8]. Reirradiation and concurrent ETT is an effective treatment for superficial tumors with randomized evidence suggesting improved complete response and local control [9].…”

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

“…Re-irradiation is used with caution due to an increased normal-tissue complication probability. Thus, only few series using EBRT alone [53,54,55] or in combination with hyperthermia for re-irradiation of the chest wall have been published so far [56,57,58,59,60,61]. Additionally, simultaneous radiochemotherapy as a further treatment option has been investigated in a limited number of trials [62,63,64].…”