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

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.

Breast; Cancer; Radiation-associated; Angiosarcoma

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