Article Data

  • Views 777
  • Dowloads 187

Case Reports

Open Access

Radiation associated angiosarcoma of the breast: a pictorial review of eleven cases highlighting a devastating complication of breast radiotherapy

  • Emma Stewart-Parker1
  • Katharine Kirkpatrick1
  • Lorraine D’Souza2
  • Duraisamy Ravichandran1,*,

1Breast Unit, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, LU4 0DZ Bedfordshire, UK

2Department of Histopathology, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, LU4 0DZ Bedfordshire, UK

DOI: 10.22514/ejgo.2023.029 Vol.44,Issue 2,April 2023 pp.109-120

Submitted: 31 October 2022 Accepted: 08 December 2022

Published: 15 April 2023

*Corresponding Author(s): Duraisamy Ravichandran E-mail: duraisamy.ravichandran@ldh.nhs.uk

Abstract

Radiation Associated Angiosarcoma (RAAS) of the breast is a rare secondary malignancy following breast radiotherapy and associated with considerable diagnostic and therapeutic challenges. We report the experience of one UK breast unit with a case series diagnosed over the last 22 years. Data was prospectively collected on all patients who presented with RAAS from 2001 to 2023, including photographs obtained following formal patient consent. The characteristics of the original breast carcinoma, treatment received, presenting features of the RAAS, subsequent management and patient outcomes were recorded. Eleven patients were identified, all women, with a median age of 57 (range 39–82) at initial breast cancer diagnosis. The dose of breast radiation received varied from 40 to 70 Gy (median 50), including boosts. The commonest presentation of RAAS was with recent-onset skin discolouration at a median time of 70 months (range: 53–168 months) after radiotherapy. Mammograms and ultrasounds were often negative. Diagnosis was confirmed largely by punch biopsy, and 82% (n = 9) went on to have surgery. The median survival from the diagnosis of RAAS was 13 months (range 7–101). RAAS is a devastating complication of breast radiotherapy, with poor prognosis. As it often presents after the traditional 5-year follow-up period for breast cancer, can appear similar to post-radiotherapy changes and be associated with “normal” imaging, so the diagnosis hinges almost entirely on clinical suspicion. Thus, it is important to be aware of the possibility of RAAS in post radiotherapy breast cancer patients.


Keywords

Breast; Cancer; Radiation-associated; Angiosarcoma


Cite and Share

Emma Stewart-Parker,Katharine Kirkpatrick,Lorraine D’Souza,Duraisamy Ravichandran. Radiation associated angiosarcoma of the breast: a pictorial review of eleven cases highlighting a devastating complication of breast radiotherapy. European Journal of Gynaecological Oncology. 2023. 44(2);109-120.

References

[1] Depla A, Scharloo-Karels C, de Jong M, Oldenbord S, Kolff M, Oei S, et al. Treatment and prognostic factors of radiation associated angiosarcoma (RAAS) after breast cancer: a systematic review. European Journal of Cancer. 2014; 50: 1779–1788.

[2] Seinen JM, Styring E, Verstappen V, Vult von Steyern F, Rydholm A, Suurmeijer AJH, et al. Radiation-associated angiosarcoma after breast cancer: high recurrence rate and poor survival despite surgical treatment with R0 resection. Annals of Surgical Oncology. 2012; 19: 2700–2706.

[3] Verdin V, Mattart L, Cusumano PG, De Hertogh O, De Meester C, Francart D, et al. Angiosarcoma associated with radiation therapy after treatment of breast cancer. Retrospective study on ten years. Cancer/RadiothéRapie. 2021; 25: 114–118.

[4] Salminen S, Sampo M, Bohling T, Salo J, Tarkkanen M, Blomqvist C, et al. Radioation-associated angiosarcoma of the breast: analysis of diagnostic tools in a registry-based population. Acta Radiologica. 2022; 63: 22–27.

[5] Sheth GR, Cranmer LD, Smith BD, Grasso-LeBeau L, Lang JE. Radiation-induced sarcoma of the breast: a systematic review. The Oncologist. 2012; 17: 405–418.

[6] Morgan EA, Kozono DE, Wang Q, Mery CM, Butrynski JE, Baldini EH, et al. Cutaneous radiation-associated angiosarcoma of the breast: poor prognosis in a rare secondary malignancy. Annals of Surgical Oncology. 2012; 19: 3801–3808.

[7] Chikarmane SA, Gombos EC, Jagadeesan J, Raut C, Jagannathan JP. MRI findings of radiation-associated angiosarcoma of the breast (RAS). Journal of Magnetic Resonance Imaging. 2015; 42: 763–770.

[8] Torres KE, Ravi V, Kin K, Yi M, Guadagnolo BA, May CD, et al. Long-term outcomes in patients with radiation-associated angiosarcomas of the breast following surgery and radiotherapy for breast cancer. Annals of Surgical Oncology. 2013; 20: 1267–1274.

[9] Mergancová J, Lierová A, Coufal O, Žatecký J, Melichar B, Zedníková I, et al. Radiation-associated angiosarcoma of the breast: an international multicenter analysis. Surgical Oncology. 2022; 41: 101726.

[10] Ronen S, Ivan D, Torres-Cabala CA, Curry JL, Tetzlaff MT, Aung PP, et al. Post-radiation vascular lesions of the breast. Journal of Cutaneous Pathology. 2019; 46: 52–58.

[11] Li GZ, Fairweather M, Wang J, Orgill DP, Bertagnolli MM, Raut CP. Cutaneous radiation-associated breast angiosarcoma. Annals of Surgery. 2017; 265: 814–820.

[12] Gutkin PM, Ganjoo KN, Lohman M, von Eyben R, Charville GW, Nazerali RS, et al. Angiosarcoma of the breast. American Journal of Clinical Oncology. 2020; 43: 820–825.

[13] Gambini D, Visintin R, Locatelli E, Galassi B, Bareggi C, Runza L, et al. Paclitaxel-dependent prolonged and persistent complete remission four years from first recurrence of secondary breast angiosarcoma. Tumori Journal. 2009; 95: 828–831.

[14] Penel N, Bui BN, Bay J, Cupissol D, Ray-Coquard I, Piperno-Neumann S, et al. Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX study. Journal of Clinical Oncology. 2008; 26: 5269–5274.

[15] Cohen-Hallaleh RB, Smith HG, Smith RC, Stamp GF, Al-Muderis O, Thway K, et al. Radiation induced angiosarcoma of the breast: outcomes from a retrospective case series. Clinical Sarcoma Research. 2017; 7: 15.

[16] Donovan EK, Corbett T, Vansantvoort J, Kak I, Popvic S, Heller B. Radical chest wall resection and hyperfractionated accelerated radiotherapy for radiation-associated angiosarcoma of the breast: a safe and effective treatment strategy. The Breast Journal. 2018; 24: 245–252.

[17] Molitoris JK, Chhabra A, Snider JW, Harvilla N, Okonkwo N, Nichols EM, et al. Intensification of treatment for angiosarcoma of the breast with accelerated hyperfractionated radiation, hyperthermia, and surgical resection. Cureus. 2017; 9: e1406.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top