Page 14 - Delaware Medical Journal - March 2016

Radiation Associated Angiosarcoma:
Case Series from a Community Cancer Center and Review of the Literature
Ian N. Wilhelm, M.D.; Emily J. Penman, M.D.
Background: Radiation associated angiosarcoma (RAAS) of the breast is a rare, but lethal complication of breast conserving surgery (BCS). Early recognition and knowledge of treatment modalities is imperative for successful treatment. We present the experience of a large community cancer center, with review of the literature.
Methods: The Christiana Care Department of Pathology and the Helen F. Graham Cancer Center and Research Institute databases were queried from 2001–2011
and 2011–2015 respectively for soft tissue neoplasms of the breast. A total of 2,153 patients with diagnosis
of malignant neoplasm of the breast not otherwise specified (NOS) were identified. There were seven cases of RAAS identified.
Results: Seven patients with RAAS were identified. Average age at presentation was 70 years with a range of 58-87. Time from radiation therapy to diagnosis was 8.5 years with a range of 4.0 years to 14.9 years. Five of seven patients presented with skin lesions, all with varying clinical signs. Clinical lymphedema was not identified in any of these patients.
Conclusion: Radiation associated angiosarcoma of the breast is an aggressive tumor with poor prognosis. Larger studies are needed to evaluate adjuvant treatments; however the small number of cases makes this prohibitive. Genetic testing and potentially targeted therapies are emerging as options for treatment and prevention of this complicated disease process.
IntroductionThe equivalence of breast conserving surgery (BCS) to total mastectomy was demonstrated in the early 1980’s and further validated with 20-year follow up.1-3 BCS has become a
standard option for the treatment of breast cancer. One of the hallmarks of BCS is whole breast radiation. While this has led to equivalent outcomes it has increased the number of women whose breasts are irradiated. This has increased the number of
women who are now at risk for radiation associated angiosarcoma (RAAS) of the breast.
Classical surgical teaching has described sarcoma of the breast as a late complication secondary to chronic lymphedema of the upper extremities. However, with the wide acceptance of breast conserving surgery there has been a trend towards sarcomas on the chest wall of patients receiving whole breast irradiation.4
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Del Med J | March 2016 | Vol. 88 | No. 3
Abstract