Radiation-induced Angiosarcoma Research Articles

Outcomes following extended resection of radiation-induced angiosarcoma of the breast: a sarcoma unit experience and systematic review.

Radiation-induced angiosarcoma (RIAS) of the breast is a rare tumour with high rate of local recurrence. The aim of this study is to evaluate the outcome of radical resections. A retrospective analysis of all patients who underwent extended surgical resection for RIAS of the breast between 2013 and 2022. Included were patients who underwent radical resection, including complete resection of previously irradiated skin and underlying fascia of pectoralis major. Post-operative and long-term oncological outcomes were than analysed. A systematic review was performed using the MEDLINE database in the last 20 years. Twenty-two (n = 22) patients met the inclusion criteria. The median length of the specimen was 220 mm (range, 120-377 mm). At a median follow-up of 33.5 months (range, 7.9-102.4), 3 (13.6%) patients had both local and metastatic lung disease and 1 (4%) patient with only lung metastasis. The estimated 3- and 5-year OS was 81.1% and 57.9%, respectively. The estimated 3- and 5-year DSS was 91.7% and 65.5%, respectively. The estimated 3- and 5-year DFS rate were both 75.2%. The systematic review identified 17 studies with a recurrence rate ranging from 33% to 100%. Treatment of RIAS of the breast with an up-front locally extended approach is associated with a low rate of local recurrence compared with the reported literature.

Angiosarcoma: a 10-year retrospective study from a high-volume UK regional referral centre.

Angiosarcoma (AS) is a rare malignancy with considerable heterogeneity seen in its aetiology, anatomical location, and clinicopathological behaviour. Diagnosis is often delayed and prognosis poor. The purpose of this study was to perform a retrospective review of all cases of AS over 10years at a high-volume regional UK referral centre. We reviewed all cases of AS discussed at the sarcoma multidisciplinary meetings of University Hospitals Birmingham NHS Foundation Trust from September 2013 to August 2023. Demographic and clinicopathologic features at diagnosis, approaches to treatment, and outcomes were compared between four AS subtypes. A total of 130 cases were identified. The median age at diagnosis was 71years, with the majority being female (78%). The most common AS subtype was radiation-induced AS (RIAS) (n = 72; 55%), followed by primary cutaneous (n = 28; 22%), primary non-cutaneous (n = 25; 19%), and AS secondary to lymphoedema (n = 5; 4%). Metastases were present at diagnosis in 18% of patients. Treatment was with surgery in the majority of patients (71%). The median survival for the cohort was 30months (95% CI 20-40), although this differed significantly by AS subtype (p < 0.001), ranging from 5months in primary non-cutaneous AS to 76months in RIAS. RIAS is the most common AS subtype, with surgery the only potentially curative treatment modality. Overall prognosis varies significantly by subtype. An international consensus on classification of AS subtypes is required to allow meaningful comparisons across studies and/or a prospective multi-centre registry.

Radiation-Induced Angiosarcoma of The Breast: A Case Report with FDG PET/CT Imaging Findings

ÖZET Giriş: Meme anjiyosarkomu, vasküler endotelden köken alan, tüm yumuşak doku meme tümörlerinin yaklaşık %1'ini oluşturan ve kötü prognoz taşıyan nadir görülen bir tümördür. İki farklı tipte ortaya çıkar: Primer meme anjiyosarkomu (PMAS) ve sekonder meme anjiyosarkomu (SMAS). PMAS tipik olarak meme kanseri veya radyoterapi öyküsü olmayan genç kadınları etkiler; sıklıkla meme parankiminden kaynaklanır ve ara sıra cilt tutulumuyla birlikte hızla büyüyen, genellikle ağrısız, ele gelen bir kitle olarak ortaya çıkar. Buna karşın SMAS yaşlı kadınlarda görülür, meme dermisinden kaynaklanır, bazen parankimi tutar, multifokalite gösterir. Ciltte renk değişikliği ve şişlik gibi karakteristik özellikler sunar. Mevcut literatürde, memenin radyasyonla ilişkili anjiyosarkomunu Flor-18 florodeoksiglukoz pozitron emisyon tomografisi/bilgisayarlı tomografi (FDG PET-BT ) kullanılarak yapılan görüntüleme bulguları ile rapor eden vakaların eksikliği bulunmaktadır. Bu vaka raporu, sol meme kanseri nedeniyle meme koruyucu cerrahi ve ardından radyoterapi uygulanan 55 yaşındaki kadın hastayı ayrıntılarıyla anlatmaktadır. Olgu: Spesifik olmayan mamografik ve ultrason özellikleri olan hastada radyoterapiden 48 ay sonra radyasyona bağlı anjiyosarkom gelişti. FDG PET-BT'de meme derisinde FDG tutulumunun arttığı nodüler lezyonlar görüldü. Artmış FDG tutulumu gösteren bu nodüllerin yapılan patolojik inceleme sonucunda radyasyona bağlı meme anjosarkomu olduğu doğrulandı. Hastaya tedavi amacıyla total mastektomi operasyonu yapıldı. Sonuç: Meme koruyucu cerrahi ve radyoterapi öyküsü olan hastalarda, takip sırasında semptomların ortaya çıkması, radyasyona bağlı anjiyosarkomun gelişimini akla getirmelidir. Erken tanı çok önemlidir ve FDG PET-BT lokal görüntüleme ve uzak organ metastazı taraması açısından faydalı olabilir. Anahtar Kelimeler: Radyasyona bağlı anjiosarkom, Meme Koruyucu Cerrahi, Radyoterapi, FDG PET-BT

Secondary radiation-induced angiosarcoma of the breast in a patient with a history of infiltrating ductal carcinoma: a case report

Secondary radiation-induced angiosarcoma of the breast in a patient with a history of infiltrating ductal carcinoma: a case report

Radiation-induced angiosarcoma of the breast: an uncommon polymorphic disorder.

Radiation-induced angiosarcoma of the breast: an uncommon polymorphic disorder.

Radiation-induced angiosarcoma of the breast: retrospective analysis at a regional treatment centre.

Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer. Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England. 22 patients were identified between 2010 and 2022. Median age of diagnosis was 65years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5years (range 2.4-16.0)-this interval has decreased over the last 24years (r2 = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72years had a median OS of 45months vs 102months for those ≤ 72years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086). RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.

An Update on Radiation-Induced Angiosarcoma of the Breast: A Diagnostic and Management Challenge

Background: Post-radiation angiosarcoma (AS) of the breast, also known as radiation-associated angiosarcoma (RAAS) or radiation-induced angiosarcoma (RIAS), is a rare complication after breast radiotherapy. The diagnosis and management of post-radiation AS is challenging because of its non-specific but aggressive presentation. This study aims to examine the experience of a local health district with post-radiation AS to improve awareness of this condition. Methods: A retrospective case series was performed on patients diagnosed with post-radiation AS within Western Sydney Local Health District between 2000-2021. Eligibility criteria included patients with histologically proven breast angiosarcoma and a history of past breast radiotherapy. Results: 11 patients had post-radiation AS of the breast. The annual incidence was 1 in 18,000 of the breast radiotherapy treated population. Descriptive analysis was performed on six patients. The median age was 67 years, with a median latency period of 5.5 years. All patients presented with non-specific skin changes. Core/punch biopsy was inconclusive in five patients. Mastectomy was the mainstay of treatment. Three patients had disease recurrence. The five-year survival rate was 68%. Conclusion: Post-radiation AS of the breast is a rare disease associated with a poor prognosis due to its aggressive nature and high recurrence rate. Diagnosis is challenging with high false-negative rates associated with imaging and biopsy. It is important to maintain a high index of suspicion in patients treated with past breast radiotherapy.

Multiple post-radiation angiosarcoma of the breast: rare clinical case

This article describes the rare clinical case of multiple radiation-induced angiosarcoma of the breast. Angiosarcoma is a rare, aggressive tumor originating from the endothelial cells of blood vessels that can affect internal organs, but the most common localization is the skin. The frequency of angiosarcoma development in the mammary gland is less than 1% of all malignant tumors of this localization. There are primary and radiation-induced (secondary) angiosarcomas. The reason for describing this clinical case is the rarity of this pathology, relatively little experience in the diagnosis and treatment of radiation-induced angiosarcoma both in our country and abroad.

Radiation-induced angiosarcoma of the breast: individual participant meta-analysis of Japanese population.

Radiation-induced angiosarcoma (RIAS) of the breast is a very rare and poor prognostic disease. According to previous studies, the efficacy of chemotherapy for RIAS is still controversial. However, no study has assessed the prognosis of RIAS and the prognostic impact of preoperative or postoperative chemotherapy in Japanese patients. Our study aimed to assess them in Japanese people using publication data with our three patients. Thirty-nine patients diagnosed with RIAS, including 36 patients from 34 published case series, and three patients from our hospital were used for analysis. Disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed. Among the 39 patients, 36 patients (92.3%) underwent surgery. The median DFS and OS periods were 14months (range 1-75months) and 23months (range 4-84months), respectively. Chemotherapy with taxane-based regimen was administered in 13 cases (33.2%) pre- or post-operatively. DFS was significantly improved with chemotherapy in addition to surgery (p = 0.037). However, addition of chemotherapy to surgery did not improve DDFS (p = 0.09) and OS (p = 0.878). In multivariate analysis, age ≥ 70years was an independent but poor prognostic factor of DFS. Additionally, a lack of chemotherapy showed a trend to be associated with worse DFS. There was no independent variable contributing to DDFS and OS. Chemotherapy may have reduced the recurrence rate of RIAS in Japanese patients but did not improve OS. Further data are needed to confirm the efficacy and proper regimen of chemotherapy.

Is there a role for adjuvant therapy in radiation-induced angiosarcoma of the breast? A case report and review of the literature.

Angiosarcoma (AS) of the breast is very rare, accounting for 1% of all soft tissue breast tumors. AS may present as primary tumors of the breast or as secondary lesions usually associated with previous radiotherapy. Commonly, secondary AS affects older women (median age 67-71 years) with a clinical history of breast cancer. The preferred site of onset of RIAS is the edge of radiation fields, where radiation doses and tumor necrosis may be heterogeneous, resulting in a DNA damage and instability. Radical surgery is the treatment of choice, but no clear consensus exists on surgical management of breast AS. We describe an atypical case of relapsed RIAS after radical mastectomy, treated with new surgery and, considering the higher risk of recurrence, subsequent adjuvant chemotherapy with weekly paclitaxel. The frequency of radiation-induced angiosarcomas (RIAS) after breast-conserving surgery and radiotherapy has been increased to 0.14-0.5% among long survivors. Nevertheless, even if RIAS continues to be prognostically an extremely unfavorable cancer due to a high rate of recurrence, distant spread, and median overall survival (OS) of about 60 months, the benefits of loco-regional breast radiotherapy are clearly higher than the risk in developing angiosarcoma.

Establishment and characterization of the first patient-derived radiation-induced angiosarcoma xenograft model (RT-AS5)

Angiosarcomas are a heterogeneous group of rare endothelial malignancies with a complex, not completely unravelled biology. They encompass primary (sporadically occurring) angiosarcomas of several origins and secondary angiosarcomas, which often arise due to DNA damaging factors including radiotherapy or ultraviolet light exposure. The optimal treatment of metastatic angiosarcomas is unclear and the prognosis is poor. In order to discover novel treatment strategies for angiosarcomas it is important to take the heterogeneity of these tumors into account. For this reason it is also important to have preclinical models available for the different clinical subtypes. Owing to the rarity of angiosarcomas, models are scarce. So far, only five human cell lines of angiosarcomas (all of the scalp after UV exposure) are available worldwide. In this paper we describe a novel established patient-derived xenograft model of a radiotherapy-induced angiosarcoma of the breast. The tumor was characterized by a MYC amplification, CD31 and ERG immunohistochemical positivity and was further characterized by using next generation sequencing (TruSight Oncology 500) in combination with the R-package XenofilteR to separate mouse from human sequence reads.

Management of radiation-induced angiosarcoma of the breast with total mastectomy and superficial inferior epigastric artery flap reconstruction: a case report

Background: Radiation-induced angiosarcoma of the breast is a rare but serious long-term complication of radiation, often from adjuvant therapy for previous breast cancer treatment. Early lesions typically appear benign and are often misattributed to breast trauma, however the disease is rapidly progressive and has a high recurrence rate and poor prognosis. Common imaging modalities such as mammography and ultrasound are often not sensitive, though magnetic resonance imaging may be more reliable. Once the diagnosis is confirmed via histopathologic evaluation of a core-needle or punch biopsy, surgical treatment should not be delayed. Reconstruction with free flap provides an advantage over other reconstructive techniques by allowing for adequate coverage of the large defect left by maximal resection of previously-irradiated tissue with ideal oncologic and wound healing outcomes.

Neoadjuvant chemotherapy associated with enhanced local control in radiation-induced angiosarcoma of breast and chest

Neoadjuvant chemotherapy associated with enhanced local control in radiation-induced angiosarcoma of breast and chest

Radiation induced angiosarcoma of the breast – a case report

A mastectomy specimen was received from an 83-year-old female with a background of a treated breast invasive ductal carcinoma 12 years ago. Previous management had included surgery with adjuvant chemoradiotherapy, and she was now presenting with a pigmented skin lesion in the treated area. Punch biopsy showed features consistent with radiation induced angiosarcoma (RIAS) with histology showing infiltrative, anastomosing vascular spaces lined by moderately pleomorphic epithelioid cells. Immunohistochemical stains for CD31, CD34 and c-MYC were positive. A diagnosis of RIAS was confirmed on the mastectomy specimen. RIAS of the breast is a rare complication, with a current estimated incidence of 0.05–0.3% .1,2 It frequently presents at least a decade after treatment, with an irritated erythematous lesion in the skin. Early detection and surgical excision with clear margins are important to reduce recurrence as this tumour behaves particularly aggressively. Despite the current low incidence, cases over recent years are gradually rising with the increased use of adjuvant radiotherapy and there is a current overall 5-year survival rate of just 27–48%.3 We describe a case of RIAS to further expand the literature and knowledge around this currently rare, but increasingly common entity.

Experience in the treatment of radioinduced angiosarcoma of the breast in a patient with primary multiple lesions of the breast and bladder. Case report

Among the multiple primary malignant tumors, breast cancer is the most common and in most cases it is combined with the second mammary gland, uterine body, stomach, colon, skin and ovary. Breast angiosarcoma is a very rare disease with unfavorable prognosis. Radiation therapy to the area of the breast is considered to be the main risk factor for the radiation-induced angiosarcoma. Diagnosis is based on the clinical aspect, the results of morphological and immunohistochemical findings. There are no uniform standards for the treatment of this pathology; a surgical method, systemic therapy, and radiation therapy are used. The article presents a clinical case of a female patient born in 1952, who was diagnosed with synchronous multiple primary cancer in 2014: stage 2A left breast cancer (cT2N0M0); bladder cancer stage I (cT1cN0M0). After the complex treatment, the patient received adjuvant endocrine therapy with Tamoxifen. In December 2018, single bluish formations appeared in the area of the postoperative scar, followed by a rapid growth of formations on the skin within a month, with a tendency to merge and necrosis. The patient was sent for biopsy of the formations with suspected recurrence of the disease. Immunomorphological patterns correspond to the angiosarcoma in the skin of the mammary gland. A simple mastectomy was performed. After 3 months, growth of angiomyosarcoma in the soft tissues of the anterior chest wall continued. Excision of the tumor in the soft tissues of the chest was performed and the patient underwent postoperative course of radiation therapy with a single focal dose (SFD) 2.5 Gy, total boost isodose of 50 Gy. At follow-up examinations held from January to December 2021, there is no evidence for continued growth and recurrence of the disease. The presented clinical observation demonstrates the experience of diagnostics and treatment of radiation-induced angiosarcoma in the patient with multiple primary synchronous lesions of the breast and bladder.

Radiation-Induced Angiosarcoma of the Breast: A Systematic Review and Meta-Analysis

INTRODUCTION: The purpose of this study is to summarize the totality of evidence on Radiation Induced Angiosarcoma (RIAS) of the breast through a meta-analysis and systematic literature review to assess overall survival (OS), recurrence, mortality, and prognostic factors. METHODS: A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Patient demographics, index cancer, and RIAS characteristics, recurrence, and mortality data were collected. Univariate and multivariate statistical analysis were performed. Kaplan-Meier analysis was used to plot survival probabilities and log-rank statistics to determine radiation cutoff dose. RESULTS: Full-text review identified 201 studies that reported patient-specific data for 531 individual patients. The median age of RIAS diagnosis was 70. The median latency period, from index breast cancer to RIAS diagnosis, was 6.7 years. A recurrence rate of 48.13% was identified. Index breast cancer tumor size was significantly larger in patients who died vs survived (3 cm vs 2 cm, p = 0.028). A threshold radiation dose of 59 Gray was associated with decreased survival probability, p = 0.047 (Figure 1). The latency period was significantly longer for patients who received chemotherapy for their index breast cancer (90.6 vs 72.0 months, p = 0.024). Use of reirradiation as treatment for RIAS did not confer a significant mortality benefit or decrease recurrence. The 5-year overall survival was 55%.Figure 1CONCLUSION: RIAS of the breast is a highly morbid disease. Tumor size, index radiation dose, and chemotherapy use are prognostic factors of RIAS recurrence and mortality. Further research into effective treatment modalities is necessary.

Dermoscopy Performs an Important Role to Diagnose Radiation-induced Angiosarcoma on the Breast.

Citation: Seleri GT, Guilherme MR, Prestes ALO, Moreira CR. Dermoscopy performs an important role to diagnose radiation-induced angiosarcoma on the breast. Dermatol Pract Concept. 2022;12(3):e2022111. DOI: https://doi.org/10.5826/dpc.1203a111

A Multidisciplinary Approach to Complex Dermal Sarcomas Ensures an Optimal Clinical Outcome.

Simple SummaryKnowledge of cutaneous or dermal sarcomas is crucial due to the initially peaceful appearance of skin tumours, causing delays in accurate diagnoses. They can easily be mistaken for benign skin appendages or moles. This clinical entity spans from low-grade tumours with practically no metastatic potential to highly aggressive neoplasms with substantial morbidity. Initial adequate resection is the absolute mainstay of successful therapy. Extensive tissue defects after resection necessitate a multidisciplinary approach involving reconstructive surgical planning from onset. Clinical and morphological types of dermal sarcomas are presented together with examples of cases undergoing interdisciplinary treatment and advanced microsurgical reconstructive therapy. Clinicians should be aware of the types of dermal sarcomas; their specific clinical presentations and growth patterns; as well as the necessity of clear surgical margins and the significant progress in reconstructive surgery, which gives new hope for future management of complex dermal sarcomas.Primary dermal sarcomas (PDS) belong to a highly clinically, genetically and pathologically heterogeneous group of rare malignant mesenchymal tumours primarily involving the dermis or the subcutaneous tissue. The tumours are classified according to the mesenchymal tissue from which they originate: dermal connective tissue, smooth muscle or vessels. Clinically, PDS may mimic benign soft tissue lesions such as dermatofibromas, hypertrophic scarring, etc. This may cause substantial diagnostic delay. As a group, PDS most commonly comprises the following clinicopathological forms of dermal sarcomas: dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), dermal undifferentiated pleomorphic sarcoma (DUPS), leiomyosarcoma (LMS), and vascular sarcomas (Kaposi’s sarcoma, primary angiosarcoma, and radiation-induced angiosarcoma). This clinical entity has a broad spectrum regarding malignant potential; however, local aggressive behaviour in some forms causes surgical challenges. Preoperative, individualised surgical planning with complete free margins is pivotal along with a multidisciplinary approach and collaboration across highly specialised surgical and medical specialties. The present review gives a structured overview of the most common forms of dermal sarcomas including surgical recommendations and examples for advanced reconstructions as well as the current adjunctive medical treatment strategies. Optimal aesthetic and functional outcomes with low recurrence rates can be achieved by using a multidisciplinary approach to complex dermal sarcomas. In cases of extended local tumour invasion in dermal sarcomas, advanced reconstructive techniques can be applied, and the interdisciplinary microsurgeon should be an integral part of the sarcoma board.

Abstract P3-23-07: Radiation induced angiosarcoma of the breast: Chemotherapy for radiation induced angiosarcoma of the breast - An individual participant data meta-analysis of Japanese population

Abstract Background: Radiation-induced angiosarcoma (RIAS) of the breast is a very rare disease. Previous studies from other countries have been reported that patients having RIAS has a poor prognosis, and the efficacy of chemotherapy is still controversial. However, the prognosis of RIAS and the prognostic impact of pre- or postoperative chemotherapy for RIAS in Japanese population are not well known. Our study aimed to assess them in Japanese population using publication data with the cases from our institute. Methods: We obtained 36 Japanese patients data from thirty-four original articles from 2007 to 2020 and 3 patients from our database. Clinicopathological data including age at diagnosis of RIAS, surgery for RIAS, pre- or postoperative chemotherapy for RIAS, regimen of chemotherapy, tumor size, stage for primary breast cancer, and systematic treatment for breast cancer were collected. We assessed disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) using Kaplan-Meier survival curves and log rank test. Hazard ratios were estimated from Cox models. Results: The median age at diagnosis of RIAS was 73.0 years (range, 32-89 years). A median follow-up period was 22 months (range, 6-84 months). RIAS developed on the breast in 36 patients (92.3%) and on chest wall in 3 patients (7.7%). Thirty-six patients (92.3%) underwent surgery. Chemotherapy was administered to 13 cases (33.2%); preoperatively in 3 patients and postoperatively in 10 patients. All patients had received taxane-based chemotherapy. The median size of tumor in pathological examination was 43.5 mm (range, 9-100 mm). There was no difference of patient’s characteristics between patients with or without chemotherapy. The median DFS period was 14 months (range 1-75 months), and the median OS period was 22 months (range, 6-84 months). Chemotherapy in addition to surgery significantly improved DFS period (19 vs 12 months, p=0.027), and DDFS tended to be prolonged by adding chemotherapy (p=0.06). However, chemotherapy did not improved OS (p=0.878). In multivariate analysis, age ≥ 70 years and no chemotherapy for RIAS were the independent poor prognostic factors for DFS. Conclusions: Our study showed that chemotherapy might reduce recurrence rate of RIAS in Japanese patients but did not improve OS. Further studies are warranted to confirm the prognostic impact and proper regimen of chemotherapy for RIAS. Citation Format: Yuri Takehara, Naoko Matsuda, Daiki Kobayashi, Atsushi Yoshida, Junko Takei, Hiroko Tsunoda, Naoki Kanomata, Hideko Yamauchi, Naoki Hayashi. Radiation induced angiosarcoma of the breast: Chemotherapy for radiation induced angiosarcoma of the breast - An individual participant data meta-analysis of Japanese population [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-23-07.

The role of c-MYC expression in the diagnostic and clinical confirmation of radiation-induced angiosarcoma

Introduction. Angiosarcomas (ASs) arising from vascular tissue, account for 3.3% of all sarcomas and have a poor prognosis. Radiation-induced AS is a rare late complication of radiotherapy (RT) treatment and is characterized by a gene expression profile such as amplification of the MYC oncogene, by which we can distinguish primary from secondary induced tumor. Case report. For a 77-year-old female patient with early-stage endometrial adenocarcinoma, a radical hysterectomy with bilateral salpingo-oophorectomy was initially done. According to pathological risk factors, the postoperative external beam conformal RT (CRT) of the pelvis was administered with concomitant brachytherapy. Six years after the treatment, on the anterior abdominal wall, in the region of the postoperative irradiation field and surgical scar, an infiltrative AS of the skin and subcutaneous adipose tissue was histologically confirmed. The patient received six cycles of mono-adriamycin chemotherapy with verified partial regression. Additional immunohistochemical analysis (IHC) of c-MYC, Ki67, and CD34 expression showed a high proliferative index (Ki67 around 60%) and c-MYC positivity indicating the molecular pattern of radiation-induced AS. Furthermore, the high proliferative index could explain the positive response to chemotherapy. Conclusion. The novel postoperative RT techniques provide better survival and local control in risk-endometrial cancer groups with a decrease in irradiation complications. These patients with longer survival are at a higher risk of developing radiation-induced tumors as late side-effects of RT. When assessing the probability of radiation-induced AS, IHC analysis of c-MYC expression could distinguish secondary from other AS if Cahan?s criteria are fulfilled.