Research archive · This publication is preserved from the LEMMO Cancer Care library. Findings are specific to the study design and population and may not reflect current clinical practice.
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.