Radiation-induced Angiosarcomas Research Articles

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.

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.

Клинический опыт успешного лечения радиоиндуцированных ангиосарком молочной железы

Клинический опыт успешного лечения радиоиндуцированных ангиосарком молочной железы

Radiation-induced angiosarcoma of the breast

Background Radiation-induced angiosarcomas of the breast are rare secondary malignancies that occur after adjuvant radiation of breast cancer. They grow in a multifocal manner and frequently develop local recurrences. Therefore, they often pose a surgical challenge. Due to their rarity it is still unclear whether a radical surgical approach leads to a beneficial outcome. The aim of this study was to determine the prognostic significance of surgical margins. Patients and methods We retrospectively assessed the outcome of 18 patients who underwent surgical treatment at our institution. The median follow-up was 4.4 years. Univariate analyses were performed to determine the prognostic significance of the assessed factors on local recurrence-free survival (LRFS) and overall survival (OS). Results The median patient age was 66.3 years. The median latency between radiation and angiosarcoma occurrence was 6.9 years. The estimated 5-year rates for LRFS and OS were 25.0% (95% confidence interval [CI]: 7.8-47.2) and 53.8% (95% CI: 26.8-74.8). R0 resection of the primary lesion was associated with a significant improvement in LRFS (p=0.017) and OS (p=0.013). Moreover, R0 resection of the last local recurrence was also associated with a more favourable OS (p=0.040). Conclusions Due to their aggressive growth pattern and pronounced tendency to local recurrence, a radical surgical approach should be sought in the treatment of radiation-induced angiosarcomas. Wherever feasible, surgical treatment should aim at R0 margins in order to improve local control and OS.

P138. Do patients diagnosed with phyllodes breast tumours need long term follow up?

P138. Do patients diagnosed with phyllodes breast tumours need long term follow up?

Can c-myc amplification reliably discriminate postradiation from primary angiosarcoma of the breast?

PurposeBreast angiosarcomas are rare vascular malignancies that arise secondary to irradiation or de novo as primary tumours. The aim of this study is to know whether c-myc amplification can reliably discriminate these two entities. Materiel and methodsForty-seven patients treated for breast angiosarcomas were studied. Thirty-two patients were diagnosed with postradiation angiosarcomas after breast cancer treatment and 15 patients with primary angiosarcomas. Interphase fluorescence in situ hybridization (FISH) was performed by hybridization of probes covering C-MYC (chromosome 8q24.21) and CEP8 on tissue sections. ResultsAmplification (5- to 20-fold) of the c-myc oncogene was found in all breast radiation-induced angiosarcomas (32 tumours) but in none of the 15 primary angiosarcomas except one (7%). ConclusionThis study reinforces that there are true pathogenetic differences between the two types of breast angiosarcomas which are morphologically indistinguishable. These data point the pathways preferentially involved in the pathogenesis of post radiation angiosarcomas of the breast and may provide the basis for an additional targeted therapy.

Radiation-induced angiosarcoma

Radiation-induced angiosarcomas are uncommon adverse sequelae related to treatment of tumors. Early diagnosis and treatment are key to successful management. The purpose of this case study is to describe the clinical characteristics of radiation-induced angiosarcomas. We retrospectively reviewed the medical literature using PubMed, searching the terms angiosarcoma, breast, post, radiation, and treatment. Patient reports and previous reviews of the subject were critically assessed and the salient features are presented. Approximately one hundred patients have been diagnosed with radiation-induced angiosarcomas. The condition presents within the radiation field, approximately six years after initial treatment. We describe the dramatic efficacious response of our patient's angiosarcoma to adjuvant chemotherapy both preoperatively (gemcitabine and docetaxel) and postoperatively (gemcitabine and docetaxel followed by ifosfamide and adriamycin). We recommend that new skin lesions within or adjacent to radiation ports should be considered for biopsy. Also, for lesions that are larger, ill-defined, or both, several sites should be sampled to ensure an accurate diagnosis and to prevent the possibility of a false negative interpretation.

High frequency of MYC gene amplification is a common feature of radiation‐induced sarcomas. Further results from EORTC STBSG TL 01/01

Irradiation is a major causative factor among the small subgroup of sarcomas with a known etiology. The prognosis of radiation-induced sarcomas (RIS) is significantly worse than that of their spontaneous counterparts. The most frequent histological subtypes include undifferentiated pleomorphic sarcomas, angiosarcomas, and leiomyosarcomas. A high frequency of MYC amplifications in radiation-induced angiosarcomas, but not in primary angiosarcomas, has recently been described. To investigate whether MYC amplifications are also frequent in RIS other than angiosarcomas, we analyzed the MYC amplification status of 83 RIS and 192 sporadic sarcomas by fluorescence in situ hybridization. We found significantly higher numbers of MYC amplifications in RIS than in sporadic sarcomas (P < 0.0001), especially in angiosarcomas, undifferentiated pleomorphic sarcomas, and leiomyosarcomas. Angiosarcomas were special in that MYC amplifications were particularly frequent and always high level, while other RIS showed low-level amplifications. We conclude that MYC amplifications are a frequent feature of RIS as a group and may contribute to the biology of these tumors.

32LBA High level gene amplification of MYC characterizes radiation-induced angiosarcomas

32LBA High level gene amplification of MYC characterizes radiation-induced angiosarcomas

Radiation induced angiosarcoma a sequela of radiotherapy for breast cancer following conservative surgery.

Radiation induced angiosarcomas (RIA) can affect breast cancer patients who had radiotherapy following conservative breast surgery. They are very rare tumors and often their diagnosis is delayed due to their benign appearance and difficulty in differentiation from radiation induced skin changes. Therefore it is very important that clinicians are aware of their existence. We report here a case of RIA followed by discussion and review of literature.