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Breast angiosarcoma induced by radiotherapy – surgical treatment options and review of literature


Authors: O. Kubala 1;  J. Prokop 1;  L. Petráš 2;  P. Ihnát 1;  P. Jelínek 1;  P. Ostruszka 1
Authors‘ workplace: Chirurgická klinika, FN LF Ostravské univerzity, Ostrava přednosta: doc. MUDr. I. Penka, CSc. 1;  Popáleninové centrum FN Ostrava primářka: MUDr. Z. Němečková Crkvenjaš, MBA 2
Published in: Rozhl. Chir., 2017, roč. 96, č. 8, s. 353-358.
Category: Case Report

Overview

Introduction:
Radiation-induced angiosarcoma is a rare but very aggressive tumour. The highest risk of sarcoma development is in patients after breast-conserving surgery.

Case 1:
The 66 years old patient underwent radical mastectomy with axillary dissection because of ductal carcinoma with consequent radiotherapy, chemotherapy and hormonal therapy. After 6 years, high-grade angiosarcoma was diagnosed and resected with negative resection margins. Within subsequent 24 months, additional three radical re-excisions were performed because of repeated sarcoma recurrence. 29 months from the diagnosis of the first sarcoma, another radical re-excision was performed, this time with positive resection margins and with consequent disease progression. The patient died three years after the first angiosarcoma diagnosis.

Case 2:
The 68 years old patient underwent breast-conserving surgery with axillary dissection because of ductal carcinoma and radiotherapy. Breast colour changes were observed 6 years later; radical mastectomy was performed after additional 16 months due to locally advanced angiosarcoma. Given positive resection margin, radical re-excision with musculocutaneous musculus latissimus dorsi flap was done. 24 months later, a small sarcoma recurrence was detected near the upper resection margin, which was managed by radical re-excision. 52 months after radical operation, a metastasis was diagnosed by means of PET/CT in the contralateral axilla. Radical axillary dissection was performed (two metastases were found in axillary lymph nodes). According to follow-up, the patient has been free of any recurrence for 66 months from the radical surgery.

Conclusion:
Recommendations regarding the management of radiotherapy induced breast angiosarcoma are very vague due to limited evidence. Radical surgical excision with negative resection margins (potentially with complementary flap reconstruction) presents the fundamental approach to breast angiosarcoma.

Key words:
radiation-induced angiosarcoma – breast cancer – surgery


Sources

1. Porter CA, White CJ. Multiple carcinomata following chronic x-ray dermatitis. Ann Surg 1907;46: 649−71.

2. Vojtíšek R, Kinkor Z, Fínek J. Sekundární angiosarkomy po konzervativní léčbě nádorů prsu. Klin Onkol 2011;24:382−8.

3. Turner WH, Greenall MJ. Sarcoma induced by radiotherapy after breast conservation surgery. Br J Surg 1991;78:1317−8.

4. Fineberg S, Rosen PP. Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol 1994;102:757−63.

5. Hodgson NC, Bowen-Wells C, Moffat F, et al. Angiosarcomas of the breast: a review of 70 cases. Am J Clin Oncol 2007;30:570−3.

6. Polgár C, Orosz Z, Szerdahelyi A, et al. Postirradiation angiosarcoma of the chest wall and breast: issues of radiogenic origin, diagnosis and treatment in two cases. Oncology 2001;60:31−4.

7. Monroe AT, Feigenberg SJ, Mendenhall NP. Angiosarcoma after breast-conserving therapy. Cancer 2003;97:1832−40.

8. Sessions SC, Smink RD Jr. Cutaneous angiosarcoma of the breast after segmental mastectomy and radiation therapy. Arch Surg 1992;127:1362−3.

9. Cozen W, Bernstein L, Wang F, et al. The risk of angiosarcoma following primary breast cancer. Br J Cancer 1999;81:532−6.

10. Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1948;1:64−81.

11. Virtanen A, Pukkala E, Auvinen A. Angiosarcoma after radiotherapy: a cohort study of 332,163 Finnish cancer patients. Br J Cancer 2007;97:115−7.

12. Pierce SM, Recht A, Lingos TI, et al. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 1992;23:915−3.

13. Chen KTR, Hoffman KD, Hendricks EJ. Angiosarcoma following therapeutic irradiation. Cancer 1979;44:2044−8.

14. Hardy TJ, An T, Brown PW, et al. Postirradiation sarcoma (malignant fibrous histiocytoma) of axilla. Cancer 1978;42:118−24.

15. Tsuneyoshi M, Enjoji M. Postirradiation sarcoma (malignant fibrous histiocytoma) following breast carcinoma: An ultrastructural study of a case. Cancer 1980;45:1419−23.

16. Edeiken S, Russo DP, Knecht J, et al. Angiosarcoma after tylectomy and radiation therapy for carcinoma of the breast. Cancer 1992;70:644−7.

17. Thijssens KM, van Ginkel RJ, Suurmeijer AJ, et al. Radiation-induced sarcoma: A challenge for the surgeon. Ann Surg Oncol 2005;12:237−45.

18. Blanchard DK, Reynolds C, Grant CS, et al. Radiation-induced breast sarcoma. Ann J Surg 2002;184:356−8.

19. Rosen PP, Kimmel M, Ernsberger D. Mammary angiosarcoma. The prognostic significance of tumor differentiation. Cancer 1988;62:2145−51.

20. Barrow BJ, Janjan NA, Gutman H, et al. Role of radiotherapy in sarcoma of the breast – a retrospective review of the M.D. Anderson experience. Radiother Oncol 1999;52:173−8.

21. Biswas T, Tang P, Muhs A, et al. Angiosarcoma of the breast: A rare clinicopathological entity. Am J Clin Oncol 2009;32:582−6.

22. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet 2005;366:2087−106.

23. Kirova YM, Vilcoq JR, Asselain B, et al. Radiation-induced sarcomas after radiotherapy for breast carcinoma: A large-scale single-institution review. Cancer 2005;104:856−63.

24. McGowan TS, Cummings BJ, O´Sullivan B, et al. An analysis of 78 breast sarcoma patients without distant metastases at presentation. In J Radiat Oncol Biol Phys 2000;46:383−90.

25. Yap J, Chuba PJ, Thomas R, et al. Sarcoma as a second malignancy after treatment for breast cancer. Int J Radiat Oncol Biol Phys 2002;52:1231−7.

26. Fisher B, Anderson SJ. The breast cancer alternative hypothesis: Is there evidence to justify replacing it? J Clin Oncol 2010;28:366−74.

27. Cahan WG, Woodward HQ, Highinbotham NL, et al. Sarcoma arising in irradiated bone: report of eleven cases. Cancer 1948;1:3−29.

28. Fodor J, Orosz Z, Szabó E, et al. Angiosarcoma after conservation treatment for breast carcinoma: our experience and a review of the literature. J Am Acad Dermatol 2006;54:499−504.

29. Kim MK, Huh SJ, Kim DY, et al. Secondary angiosarcoma following irradiation-case report and review of the literature. Radiat Med 1998;16:55−60.

30. Del Mastro L, Garrone O, Guenzi M, et al. Angiosarcoma of the residual breast after conservative surgery and radiotherapy for primary carcinoma. Ann Oncol 1994;5:163−5.

31. Clarke D, Martinez A, Cox RS, et al. Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy. Cancer 1982;49:2295−9.

32. Zietz C, Rössle M, Haas C, et al. MDM-2 oncoprotein overexpression, p53 gene mutation, and VEGF up-regulation in angiosarcomas. Am J Pathol 1998;153:1425−33.

33. McLaughlin ER, Brown LF, Weiss SW, et al. VEGF and its receptors are expressed in a pediatric angiosarcoma in a patient with Aicardi´s syndrome. J Invest Dermatol 2000;114:1209−10.

34. Solnic Z, Salopek D, Jazvic M, et al. Parenchymal post-irradiation angiosarcoma: A case report. Acta Clin Croat 2009;48:433−7.

35. Sener SF, Milos S, Feldman JL, et al. The spectrum of vascular lesions in the mammary skin, including angiosarcoma, after breast conservation treatment for breast cancer. J Am Coll Surg 2001;193:22−8.

36. Bolin DJ, Lukas GM. Low-grade dermal angiosarcoma of the breast following radiotherapy. Am Surg 1996;62:668−72.

37. Lamblin G, Oteifa M, Zinzindohoue C, et al. Angiosarcoma after conservative treatment and radiation therapy for adenocarcinoma of the breast. Eur J Surg Oncol 2001;27:146−51.

38. Lucas DR. Angiosarcoma, radiation-associated angiosarcoma, and atypical vascular lesion. Arch Pathol Lab Med 2009;133:1804−9.

39. Mermershtain W, Cohen AD, Koretz M, et al. Cutaneous angiosarcoma of breast after lumpectomy, axillary lymph node dissection, and radiotherapy for primary breast carcinoma: Case report and review of the literature. Am J Clin Oncol 2002;25:597−8.

40. Edge SB, Byrd DR, Compton CC, et al. AJCC soft tissue sarcoma. New York, Springer 2010:291−8.

41. De Smet S, Vandermeeren L, Christiansens MR, et al. Radiation-induced sarcoma: Analysis of 46 cases. Acta Chir Belg 2008;108:574−9.

42. Brennan MF, Winter S, Maki RG. Sarcomas of the soft tissues and bone. In: DeVita, Hellman and Rosenberg´s Cancer: Principles and Practice of Oncology. 8th ed. Philadelphia, Lippincott Williams & Wilkins 2008:1741−93.

43. Marchal C, Weber B, de Lafontan B, et al. Nine breast angiosarcomas after conservative treatment for breast carcinoma: a survey from French comprehensive cancer centers. Int J Radiat Oncol Biol Phys 1999;44:113−9.

44. Liberman L, Dershaw DD, Kaufman RJ, et al. Angiosarcoma of the breast. Radiology 1992;183:649−54.

45. Williams EV, Banerjee D, Dallimore N, et al. Angiosarcoma of the breast following radiation therapy. Eur J Surg Oncol 1999;25:221−2.

46. Brenin CM, Small W Jr, Talamonti MS, et al. Radiation-induced sarcoma following treatment of breast cancer. Cancer Control 1998;5:425−32.

47. Rao J, Dekoven JG, Beatty JD, et al. Cutaneous angiosarcoma as a delayed complication of radiation therapy for carcinoma of the breast. J Am Acad Dermatol 2003;49:532−8.

48. Plotti F, Di Donato V, Zullo MA, et al. An unusual case of secondary fibrosarcoma after treatment for breast cancer. Gynecol Oncol 2006;103:1133−6.

49. Borman H, Safak T, Ertoy D. Fibrosarcoma following radiotherapy for breast carcinoma: A case report and review of the literature. Ann Plast Surg 1998;41:201−4.

50. Fant J, Grant M, May S, et al. Angiosarcoma of the breast: Mammographic, clinical, and pathologic correlation. Breast J 2003;9:252−3.

51. Erel E, Vlachou E, Athanasiadou M, et al. Management of radiation-induced sarcomas in a tertiary referral centre: A review od 25 cases. Breast 2010;19:424−7.

52. Chapelier AR, Bacha EA, de Montpreville VT, et al. Radical resection of radiation-induced sarcoma of the chest wall: Report of 15 cases. Ann Thorac Surg 1997;63:214−9.

53. West JG, Quershi A, West JE, et al. Risk of angiosarcoma following breast conservation: A clinical alert. Breast J 2005;11:115−23.

54. Bjerkehagen B, Smeland S, Walberg L, et al. Radiation-induced sarcoma: 25-year experience from the Norwegian Radium Hospital. Acta Oncol 2008;47:1475−82.

55. Adhikari D, Hajdu SI, Levine D. Post-radiation angiosarcoma and bilateral mastectomy. Ann Clin Lab Sci 2002;32:428−33.

56. Wijnmaalen A, van Ooijen B, va Geel BN, et al. Angiosarcoma of the breast following lumpectomy, axillary node dissection, and radiotherapy for primary breast cancer: Three case reports and a review of the literature. Int J Radiat Oncol Biol Phys 1993;26:135−9.

57. Colville RJ, Ramsden A, Malcolm A, et al. Angiosarcoma of the breast after quadrantectomy and postoperative radiotherapy for carcinoma. Br J Plast Surg 1991;78:1317−8.

58. Turner WH, Greenall MJ. Sarcoma induced by radiotherapy after breast conservation surgery. Br J Surg 1991;78:1317−8.

59. Feigenberg SJ, Mendenhall NP, Reith JD, et al. Angiosarcoma after breast-conserving therapy: Experience with hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys 2002; 52:620−6.

60. Brady MS, Gaynor JJ, Brennan MF. Radiation-associated sarcoma of bone and soft tissue. Arch Surg 1992;127:1379−85.

61. Kuten A, Sapir D, Cohen Y, et al. Postirradiation soft tissue sarcoma occuring in breast cancer patients: Report of seven cases and results of combination chemotherapy. J Surg Oncol 1985;28:168−71.

62. Lagrange JL, Ramaioli A, Chateau MC, et al. Sarcoma after radiation therapy: Retrospective multiinstitutional study of 80 histologically confirmed cases. Radiation Therapist and Pathologist Groups of the Fédération Nationale des Centres de Lutte Contre le Cancer. Radiology 2000;216:197−205.

63. Quadros CA, Vasconcelos A, Andrade R, et al. Good outcome after neoadjuvant chemotherapy and extended surgical resection for a large radiation-induced high-grade breast sarcoma. Int Semin Surg Oncol 2006;3:18.

64. Strobbe LJ, Peterse HL, van Tinteren H, et al. Angiosarcoma of the breast after conservation therapy for invasive cancer, the incidence and outcome. An unforeseen sequela. Breast Cancer Res Treat 1998;47:101−9.

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