P2.15: Treatment Outcome of Metastatic Breast Angiosarcoma to the Lung, in a Reference Hospital in Latin America: A Case Report

Abstract

Breast Angiosarcomas (BAs), are very rare, they are classifed Primary and Secondary, as a complication of the treatment (Mastectomy or radiotherapy) for breast cancer. Occurs frequently in younger women (20 – 50 yo) with no previous cancer, family history or risk factors. Primary BAs incidence of 17 new cases per million women, and accounts for 0.04% of all breast malignancies. Angiosarcomas arise from the endothelial lining of the blood vessels, mainly in soft tissue and skin, it is rapidly progressive with a poor prognosis compared to other breast malignancies. Although there is not a standardized treatment, surgery has been used as first line treatment with chemotherapy and radiotherapy as adjuvants. Lately the use of Liposomal Doxorubicin and Bevacizumab has been increasing with very favorable responses. The BAs principal metastatic places are lung, bone, liver, and thorax. We describe a case of a patient with BAs, during her evolution presents a metastatic lesion to the lung. Review of medical history, radiological and pathological studies. Woman, 63 years old, with diagnosis of left BAs (intermediate grade), treated with left mastectomy, later with a local recurrence, affecting muscle in the left breast, lung metastasis (intermediate grade) was developed with only lesion in lower left lobe, mixed component, solid and ground glass, treated with lower left lung lobectomy, during the evolution developed cutaneous angiosarcoma, scalp, liver and meningeal carcinomatosis, in the last admission presented with intermittent heavy bleeding, from upper airway lesions. The patient is currently being treated with Liposomal Doxorubicin and Bevacizumab, with significant regression of metastatic lesions, intermediate tolerance because of the adverse effects. From the oncological point of view with this treatment the patient has a satisfactory evolution. The importance of this case is that the Primary BAs is a rare disease, that can develop without prior exposure to surgical procedures or radiation. The metastatic or disseminated presentation represents a therapeutic challenge, in this case the implementation of antiangiogenic therapy (Bevacizumab) and the chemotherapeutic agent (Liposomal Doxorubicin), have achieved and adequate sustained treatment outcome, allowing and individualized treatment to metastasis, as the case of the lung injury that was successfully resected.