Angiosarcoma of the Breast Following Lumpectomy and Radiation Therapy for Breast Carcinoma: Case Report and Review of the Literature

Treatment and prognostic factors of radiation-associated angiosarcoma (RAAS) after primary breast cancer: a systematic review

BACKGROUND

Radiation-associated angiosarcoma (RAAS) of the breast is a rare, aggressive disease. The incidence is increasing with the prolonged survival of women irradiated for primary breast cancer. Surgery is the current treatment of choice. Prognosis is poor. This review aims to evaluate all publications on primary treatment of RAAS to identify prognostic factors and evaluate treatment modalities.

METHODS

Databases were searched for articles with published individual patient data on prognostic factors, treatment and follow-up of patients with RAAS. A regression analysis was performed to test the prognostic values of age, interval between primary treatment and RAAS, tumour size and grade on the local recurrence-free interval (LRFI) and overall survival (OS). The effects of treatment modalities surgery, radiation (with or without hyperthermia) and chemotherapy or combinations were evaluated.

RESULTS

74 articles were included, representing data on 222 patients. In these patients, the 5-year OS was 43% and 5-year LRFI was 32%. Tumour size and age were significant prognostic factors on LRFI and OS. Of all patients, 68% received surgery alone, 17% surgery and reirradiation and 6% surgery with chemotherapy. The remaining 9% received primary treatments without surgery. Surgery with radiotherapy had a better 5-year LRFI of 57% compared to 34% for surgery alone (p=0.008). The value of other treatment modalities could not be assessed.

CONCLUSIONS

This systematic review confirms the poor prognosis of RAAS. Tumour size and age were of prognostic value. The addition of reirradiation to surgery in the treatment of RAAS appears to enhance local control.

Myofibroblastoma in the Irradiated Breast

Myofibroblastoma after wide excision and radiation therapy for intraductal (duct carcinoma in situ) carcinoma is reported. Myofibroblastoma is a benign tumor, largely composed of myofibroblasts arranged in fascicular clusters with interspersed bands of hyalinized collagen, which is well circumscribed and occurs predominantly in men. This is the first documented instance of a postradiation myofibroblastoma of the breast.