Recurring radiation-induced angiosarcoma of the breast that was treated with paclitaxel chemotherapy: a case report

Abstract

Background: Angiosarcoma of the breast is very rare and can be divided into primary and secondary angiosarcoma. Radiation-induced angiosarcoma (RIAS) is classified as secondary angiosarcoma. Diagnosis of RIAS is difficult due to its rarity, and the interpretation of pathological imaging is complicated. In the National Comprehensive Care Network (NCCN) guidelines, the first choice of treatment is surgery with negative margins. Adjuvant radiotherapy (RT) for close soft tissue margins should be considered. Preoperative or adjuvant chemotherapy of nonmetastatic disease is not recommended for angiosarcoma. We report a case of RIAS, which was impossible to diagnose with core needle biopsy (CNB) but was diagnosed by excisional biopsy. The patient was then administered adjuvant chemotherapy using conjugated paclitaxel (PTX). Case presentation: A 62-year-old woman noticed a tumor in her right breast. She had a history of right breast cancer and had undergone breast-conserving surgery, RT, and tamoxifen therapy 8 years previously. CNB, which was performed twice, was inconclusive. The tumor was surgically excised and pathological analysis yielded a diagnosis of angiosarcoma. She then underwent a right mastectomy. One month after she underwent right mastectomy, a nodule reappeared on the skin of her right breast, and excisional biopsy revealed recurrence of angiosarcoma. A few weeks later another nodule reappeared near the post-operative scar and excisional biopsy revealed recurrence of angiosarcoma. We assumed that surgical therapy was insufficient because the patient experienced relapse of angiosarcoma after complete mastectomy. After the second recurrence, we treated her with systemic chemotherapy using PTX. There was no evidence of recurrence 8 months after chemotherapy. Conclusion: Although angiosarcoma is difficult to diagnose, many patients have a poor prognosis. Therefore, prompt treatment intervention is desired. Moreover, there is little evidence regarding adjuvant therapy of angiosarcoma since it is a rare disease. We consider that adjuvant therapy helped to effectively prevent recurrence in the patient after complete excision.

Primary angiosarcoma of breast: A case report and literature review

“…In most cases, most patients choose to use adjuvant chemotherapy, but the types and schemes of drugs are diverse, and the curative effect is still uncertain. Paclitaxel can significantly prolong the recurrence-free survival time of patients [19] . In addition, chemotherapy regimens based on anthracycline or epirubicin and ifosfamide can significantly improve disease-free survival and overall survival [20] .…”

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

“…An oncologic resection alone can fail to provide adequate local control [ 24 ]. Even with uninvolved margins, recurrences may occur owing to the infiltrative nature of RAAS [ 3 , 22 , 25 , 27 , 28 , 36 , 37 ]. The 2 patients in this series who underwent upfront mastectomy (patients 4 and 6) exemplify this problem; despite uninvolved margins, the disease rapidly recurred within 9 weeks after mastectomy.…”

“…Treatment intent was curative in all patients and incorporated HART, as previously described [ 3 , 4 , 27 ]. Patients referred after surgery received postoperative HART; however, when possible, we favored preoperative HART as it (1) allows for maximal excision of twice-irradiated tissue; (2) allows for downsizing of the tumor that may facilitate an R0 resection, which is associated with improved outcomes [ 19 ]; and (3) reduces the risk of rapid and early recurrence during convalescence after mastectomy [ 3 , 18 , 22 , 25 , 27 , 28 ].…”

“…Surgical excision with wide margins is the mainstay of treatment for localized RAAS. Mastectomy is the most common surgery; unfortunately, local recurrence is common even with complete resection [6,21,22], possibly owing to diffuse infiltration or multifocality [23]. After surgery alone, local recurrence rates can reach 92% [7,12,14,15,18,[24][25][26].…”

“…After surgery alone, local recurrence rates can reach 92% [ 7 , 12 , 14 , 15 , 18 , 24 – 26 ]. These recurrences can be rapid and often occur near or at the surgical incision [ 3 , 22 , 25 , 27 , 28 ]. RAAS is a radiosensitive tumor, and adjuvant RT has been recommended to improve outcomes [ 13 , 21 , 24 – 26 , 29 , 30 ].…”