Angiosarcoma of the breast: a difficult surgical challenge.

Abstract

BACKGROUND AND OBJECTIVES:

Breast angiosarcoma presents following radiotherapy after breast conserving surgery, in the setting of chronic lymphoedema after axillary dissection or as a primary tumour. The Peter MacCallum Cancer Centre has significant experience due to large breast and sarcoma units and as a primary radiotherapy centre. Our aims were to evaluate the management and locoregional and distant outcomes after breast angiosarcoma.

METHODS:

Retrospective study of all patients from the prospective breast and sarcoma databases with a diagnosis of primary or secondary breast angiosarcoma at Peter MacCallum Cancer Centre was performed between January 2000 and December 2010. Mode of presentation, management, loco-regional recurrence and survival rates were reviewed.

RESULTS:

Eight women developed angiosarcoma in the setting of breast conservation with a median latency of 7 years post radiotherapy. Six patients had primary breast angiosarcoma. All breast angiosarcomas were managed with total mastectomy with 5 patients requiring autologous tissue transfer. Four patients had adjuvant radiotherapy and three patients had adjuvant paclitaxel. The median follow-up was 2.5 years (6 month-10 years) with 7 episodes of local recurrence in four patients and 7 patients with distal metastases including two deaths from distant disease.

CONCLUSIONS:

Primary angiosarcoma occurs de novo, presenting as a breast mass. Secondary angiosarcoma presents predominantly as a skin lesion, in the setting post-operative radiotherapy for breast conserving therapy. Angiosarcoma remains a rare and difficult management problem with poor loco-regional and distal control. Secondary AS is an iatrogenic condition that warrants close follow-up and judicial use of radiotherapy in breast conserving therapy.

• Authors: Aaron Hui, Michael Henderson, David Speakman, Anita Skandarajah
• Journal: Breast (Edinburgh, Scotland) (Breast) Vol. 21 Issue 4 Pg. 584-9 (Aug 2012) ISSN: 1532-3080 [Electronic] Netherlands
• PMID: 22305554 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Antineoplastic Agents, Phytogenic
• Paclitaxel

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Phytogenic (therapeutic use)
• Breast Neoplasms (mortality, pathology, surgery, therapy)
• Chemotherapy, Adjuvant
• Female
• Follow-Up Studies
• Hemangiosarcoma (mortality, pathology, surgery, therapy)
• Humans
• Mastectomy
• Middle Aged
• Neoplasm Recurrence, Local
• Paclitaxel (therapeutic use)
• Radiotherapy, Adjuvant
• Retrospective Studies
• Survival Rate
• Treatment Outcome