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Radiation-induced sarcoma of the breast is an iatrogenic malignancy that occurs secondary to radiotherapy, which is most commonly given following breast conservation surgery. It has an incidence of 3.2 per 1,000 patients at 15 years and is associated with a poor prognosis. We report a 62-year-old female with a history of bilateral breast conservati...
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Citations
... The initial management of patients affected by radiation-induced breast angiosarcoma (RIAS) is complex due to the fact that it usually presents in the form of multifocal reddish-purple papular skin lesions underestimated by clinicians because of its benign presentation and skin changes are easily attributed to radiation even if radiation-induced breast angiosarcoma RIAS are frequently associated with a poor prognosis [3][4][5]. An incisional biopsy of the skin and underlying mass is necessary and the treatment is surgical resection, however the role of chemotherapy has not yet been clearly defined. ...
We describe a rare case of a 77-year-old woman with radiation-induced breast angiosarcoma (RIAS) in whom radical surgery with negative margins determined that at 14-month of follow-up there is no evidence of either local or systemic recurrence without having to resort to adjuvant chemotherapy.
... Rarely do patients develop toxicities after BCT that can result in significant morbidity and present treatment challenges. Radiation-associated angiosarcoma (RAAS), however, is a rare secondary malignancy with an incidence of 0.03% to 0.3% [1,2] and a median latency period of 5 to 9 years after RT [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16]. RAAS is an aggressive tumor with a propensity towards local recurrence and tends to have a poor prognosis [5,10,12,[16][17][18]. ...
... All had undergone BCT involving lumpectomy, axillary surgery, and adjuvant whole-breast RT. The median age at RAAS diagnosis was 73 (range, 60-83) years with a median latency of 8.9 (range, [5][6][7][8][9][10][11][12][13][14] years between completion of RT and RAAS diagnosis. All 6 patients had a baseline Zubrod performance status score of 0 or 1 at the time of HART. ...
... The 4 patients who received HART in the preoperative setting received total doses from 60 to 70 Gy (patients 1, 3, 5 and 6). The median interval from diagnosis to preoperative HART was 7 (range, [4][5][6][7][8][9][10][11][12][13][14] weeks, while the median duration between completion of HART and surgery was 49 (range, days. Three of the 4 patients treated with preoperative HART underwent reconstruction with autologous tissue transfer techniques (ie, flap reconstruction; see Supplemental Figure S7). ...
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.
... In Sri Lanka reported a bilateral synchronic angiosarcoma after surgery and radiotherapy (secondary breast angiosarcoma) in a patient of 62 years old, she develops those tumors with only 5 years of history to radiotherapy, the difference with frequent radio induced tumor between 10 or 20 years [14]. ...
Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named “radiogenic angiosarcoma of the breast”, which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.
