First report of proton beam therapy for breast angiosarcoma from the prospective PCG registry

Thorpe, C.S.; Niska, Joshua R.; Brunnhoelzl, Daniel; McGee, L.A.; Kesslering, Christy; Hartsell, William F.; Vargas, Carlos

doi:10.1080/0284186x.2017.1423179

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…All patients in our series had clinical and radiologic evidence of extensive disease, most achieved a pathologic complete response, and none developed a local recurrence (5 of 6 patients had follow-up exceeding 16 months). This series adds to a case report published on proton therapy for breast angiosarcoma in which patients were treated postoperatively with conventional fractionation to a median dose of 60 Gy [ 62 ]. Similar to our series, favorable dosimetry was achieved with proton therapy.…”

Section: Discussionmentioning

confidence: 99%

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Looi

Bradley

Liang

et al. 2022

International Journal of Particle Therapy

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Purpose Radiation-associated angiosarcoma (RAAS) is a rare complication among patients treated with radiation therapy for breast cancer. Hyperfractionated-accelerated reirradiation (HART) improves local control after surgery. Proton therapy may further improve the therapeutic ratio by mitigating potential toxicity. Materials and Methods Six patients enrolled in a prospective registry with localized RAAS received HART with proton therapy between 2015 and 2021. HART was delivered twice or thrice daily in fraction sizes of 1.5 or 1.0 Gy, respectively. All patients received 45 Gy to a large elective volume followed by boosts to a median dose of 65 (range, 60-75) Gy. Toxicity was recorded prospectively by using the Common Terminology Criteria for Adverse Events, version 4.0. Results The median follow-up duration was 1.5 (range, 0.25-2.9) years. The median age at RAAS diagnosis was 73 (range, 60-83) years with a median latency of 8.9 (range, 5-14) years between radiation therapy completion and RAAS diagnosis. The median mean heart dose was 2.2 (range, 0.1-4.96) Gy. HART was delivered postoperatively (n = 1), preoperatively (n = 3), preoperatively for local recurrence after initial management with mastectomy (n = 1), and as definitive treatment (n = 1). All patients had local control of disease throughout follow-up. Three of 4 patients treated preoperatively had a pathologic complete response. The patient treated definitively had a complete metabolic response on her posttreatment PET/CT (positron emission tomography–computed tomography) scan. Two patients developed distant metastatic disease despite local control and died of their disease. Acute grade 3 toxicity occurred in 3 patients: 2 patients undergoing preoperative HART experienced wound dehiscence and 1 postoperatively developed grade 3 wound infection, which resolved. Conclusion HART with proton therapy appears effective for local control of RAAS with a high rate of pathologic complete response and no local recurrences to date. However, vigilant surveillance for distant metastasis should occur. Toxicity is comparable to that in photon/electron series. Proton therapy for RAAS may maximize normal tissue sparing in this large-volume reirradiation setting.

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Section: Discussionmentioning

confidence: 99%

Hyperfractionated-Accelerated Reirradiation with Proton Therapy for Radiation-Associated Breast Angiosarcoma

Looi

Bradley

Liang

et al. 2022

International Journal of Particle Therapy

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“…37,38 However, a randomized phase II trial showed that paclitaxel administered once per week with bevacizumab showed no superior bene t over paclitaxel without bevacizumab in patients with advanced angiosarcoma. In several cases, CTLA-4 inhibitors, PD-1 directed therapy, proton beam therapy and photodynamic therapy showed therapeutic bene ts, [40][41][42][43] and these might be potential future options. There is a compelling need to explore novel therapeutic strategies for breast angiosarcoma.…”

Section: Discussionmentioning

confidence: 99%

Breast Angiosarcoma: a SEER Population- Based Study

Jiang

et al. 2021

Preprint

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Background Breast angiosarcoma is a rare malignancy with poor survival. Due to the paucity of data, the generation of high-quality evidence for its high-risk features and the impact of treatment modalities on survival have been hampered. Objective To examine high-risk features and the impact of treatment modalities on disease-specific survival (DSS) in breast angiosarcoma and differences between breast angiosarcoma cases with and without other prior cancers. Methods In this retrospective study, patients with breast angiosarcoma diagnosed from 1975 to 2016 were identified from the Surveillance, Epidemiology, and End Results database. Cox proportional hazards regression analysis adjusted for age, race, decade at diagnosis, location, pathologic grade, extent of disease, tumor size, and therapy to model DSS outcomes. Propensity score matching analyses were performed to adjust for the differences between breast angiosarcoma cases with and without other prior cancers to compare their DSS values. A Kaplan-Meier curve was used to visualize the cumulative survival probability. Results Of 648 patients with breast angiosarcoma, 55.4% had a prior cancer diagnosis. Older (age ≥ 70) patients were more likely to have breast angiosarcoma with prior cancer than younger patients (64.3% versus 21.8%). Via multivariate analysis, pathologic grade and extent of disease were identified to be significantly associated with DSS in breast angiosarcoma. In matched data, breast angiosarcoma patients with prior cancer had a better DSS than those without prior cancer (HR = 0.60, 95%CI 0.38–0.96, p = 0.0389). In breast angiosarcoma patients without prior cancer, patients with larger tumor size receiving surgery plus radiation or/and chemotherapy might have a better survival than those patients receiving surgery only (HR = 0.38, 95%CI 0.14–0.99, p = 0.0128). DSS is not impacted by the current therapeutic strategies in unselected breast angiosarcoma patients. Conclusions Breast angiosarcoma patients with prior cancer have a better DSS than those without prior cancer. Additionally, some breast angiosarcoma cases with prior cancer may be cutaneous angiosarcomas. Pathologic grade and extent disease are high-risk features. DSS is not impacted by the current therapeutic strategies in unselected breast angiosarcoma patients.

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“…However, whether radiation therapy can be conducted remains a question, as SBA is induced by previous radiation therapy. Additionally, reports have emerged on proton beam radiotherapy for BA postoperative treatment [ 35 ]. Hyperfractionated radiotherapy demonstrates benefits for local control and survival rates [ 3 ].…”

Section: Postoperative Adjuvant Therapymentioning

confidence: 99%