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

Introduction

Radiation induced angiosarcoma (RAS) of the chest wall/breast is one of the most aggressive types of tumor that can devel- op in an irradiated area after breast con- serving therapy (BCT) [19, 25, 31, 39, 40]. It constitutes less than 1% of all breast can- cers [39]. RAS is thus a relatively rare com- plication of BCT, but its incidence is likely to increase as more women undergo this treatment [12, 24, 32]. In three published series, the median times between BCT and RAS diagnosis were 59, 91 and 74 months [6, 7, 8]. Most cutaneous angiosarcomas are not amenable to surgical resection and a number of patients show metasta- ses at diagnosis or develop them shortly after [1]. The prognosis of RAS patients is poor and the reported 5-year overall sur- vival (OS) rate varies from 10 to 38% [9, 13, 39]. The most common cause of death is local progression along the chest wall [9]. Establishment of local control (LC) is thus important for preventing distressing symptoms [27]. The occurrence of RAS in a previously irradiated field limits the therapeutic options. In many cases, sur- gery is unfeasible and even after obtain- ing negative margins by simple mastecto- my, additional local tumors recur in ap- proximately 70% of patients (29–100%) [3,

7, 13, 16, 20, 23, 28, 29]. Full-dose re-irra- diation is usually not possible and re-ir- radiation alone does not improve surviv- al rate [21]. Re-irradiation plus hyperther- mia (reRT + HT) is an effective treatment for recurrent breast cancer with accept- able toxicity. Results from five random- ized trials have shown that the complete response (CR) rate for breast cancer re- currences increases from 41 to 59% when hyperthermia is combined with radio- therapy [36]. Multimodal therapies com- prising surgery and reRT + HT may im- prove local tumor control in the treatment of angiosarcoma [26].

In an attempt to improve LC rates, we have treated RAS patients with a combina- tion of surgery wherever this was feasible, and reRT + HT. Results of a retrospective analysis are reported here.

Linthorst-2013-Effect Of A Combined Surgery, R
Linthorst-2013-Effect Of A Combined Surgery, R
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