Postirradiation Angiosarcoma of the Chest Wall and Breast: Issues of Radiogenic Origin, Diagnosis and Treatment in Two Cases

Abstract

The authors report two cases of postradiation angiosarcoma (AS) among 5,100 breast cancer patients treated in the period 1980–1994 at the National Institute of Oncology, Budapest. Relevant data in the literature is also reviewed to analyze the questions of radiogenic origin, diagnosis and treatment. Secondary AS occurred in these cases in a previously irradiated field after a 6- and 8-year latency period, respectively. Detailed histopathological and immunohistochemical examinations from the biopsy specimens confirmed the diagnosis as AS. The first patient was treated successfully with radical surgery. The second patient, with unresectable AS, died of rapid local progression within 4 months. The incidence of chest wall and breast AS after radiotherapy was found to be 0.46 per 1,000 in our patient population, which means an estimated odds ratio of 2.9 for secondary AS. Patients treated with radiotherapy for primary breast cancer are at higher risk for developing secondary AS compared to the healthy population. An etiological relationship between radiotherapy and subsequent AS of the chest wall and breast is likely, but still controversial. Initial radical surgery is the only effective treatment for achieving long-term survival. These very rare cases deserve special attention due to the atypical clinical appearance, difficulties of differential diagnosis and poor prognosis.

Postradiation vascular proliferations: an increasing problem

“…Reasons for radiation treatment are various but include predominantly malignant and less often benign conditions. By far the most frequent clinical setting is the treatment of breast carcinoma, 5,15–44 followed by gynaecological malignancies such as ovarian, endometrial or uterine cervical carcinoma 23,45–52 . Rare reasons for radiation treatment include congenital haemangioma, acne, ringworm, graft irradiation of a renal transplant and peripheral primitive neuroectodermal tumour, melanoma and Hodgkin's disease 23,53–61 .…”

Angiosarcoma after breast‐conserving therapy

“…Over the past 20 years, breast‐conserving therapy has replaced modified radical mastectomy as the standard of care for patients with early‐stage breast carcinoma. Angiosarcoma arising in the irradiated breast after breast‐conserving therapy has been reported with increasing frequency over a similar time period 3–51. Although angiosarcoma after breast‐conserving therapy is uncommon (approximately 100 cases are reported in the literature), the incidence has increased as more women are treated with segmental mastectomy and radiotherapy.…”

Postradiation sarcomas – report of two cases and review of the literature

“…Opisywano ponad 5-krotne zwiększenie częstości występowania raka płuc i mięsaka u pacjentów po radioterapii z powodu raka piersi w porównaniu z pacjentami nienapromienianymi [4]. Według różnych autorów mięsaki rozwijające się w polu napromieniania są rozpoznawane 3 do 50 lat po przeprowadzeniu radioterapii [1,2,[5][6][7][8][9], średnio po 10-15 latach [1][2][3]. Przedstawione przypadki potwierdzają obserwacje z piśmiennictwa.…”