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Cutaneous Radiation-Associated Angiosarcoma of the Breast: Poor Prognosis in a Rare Secondary Malignancy

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cutaneous radiation-associated angiosarcoma of the breast (CRAASBr) is a rare complication of radiation therapy (RT) administered for primary breast cancer treatment. Although case series have provided clinical and histological descriptions of this disease, to our knowledge, none have identified trends in presentation and treatments that may contribute to outcomes.

Methods

Demographic, clinical, histopathologic, and outcomes data for all patients presenting with CRAASBr for treatment or consultation at our institution from 1987 to 2009 were reviewed.

Results

We identified 33 patients (median age at CRAASBr presentation 71.3 years, range 43.1–87.2 years; median latency period 73.5 months, range 39.6–148.5 months). The most common presentation was breast skin ecchymosis (55 %). In four patients, initial biopsy demonstrated atypical vascular lesions suspicious for, but not diagnostic of, angiosarcoma. All patients underwent mastectomy. Median local recurrence-free survival (LRFS), recurrence-free survival (RFS), and overall survival (OS) rates were 18.2, 13.0, and 48.5 months, respectively. Patients who underwent resection of all irradiated breast skin as part of the mastectomy trended toward a better median LRFS (80.8 vs. 10.0 months, p = 0.065), RFS (72.6 vs. 10.0 months, p = 0.098), and OS (not achieved vs. 29.0 months, p = 0.054).

Conclusions

CRAASBr is a potentially devastating consequence of RT for breast cancer, with poor LRFS, RFS, and OS rates. Patients with ecchymotic skin lesions require biopsy. Atypical vascular lesions require careful evaluation to rule out CRAASBr. If the diagnosis is confirmed, radical surgery encompassing both the breast parenchyma and the at-risk radiated skin should be performed.

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Author information

Author notes

  1. Carlos M. Mery MD, MPH

    Present address: Texas Children’s Hospital, Congenital Heart Surgery, Houston, TX, USA

  2. Alessandra F. Nascimento MD

    Present address: Department of Pathology, Baptist Hospital of Miami, Miami, FL, USA

Authors and Affiliations

  1. Department of Pathology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA

    Elizabeth A. Morgan MD & Alessandra F. Nascimento MD

  2. Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA

    David E. Kozono MD, PhD & Elizabeth H. Baldini MD, MPH

  3. Department of Biostatistics and Computational Biology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA

    Qian Wang PhD

  4. Department of Surgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA

    Carlos M. Mery MD, MPH & Chandrajit P. Raut MD, MSc

  5. Department of Medical Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA

    James E. Butrynski MD & Suzanne George MD

Authors
  1. Elizabeth A. Morgan MD
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  2. David E. Kozono MD, PhD
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  3. Qian Wang PhD
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  4. Carlos M. Mery MD, MPH
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  5. James E. Butrynski MD
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  6. Elizabeth H. Baldini MD, MPH
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  7. Suzanne George MD
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  8. Alessandra F. Nascimento MD
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  9. Chandrajit P. Raut MD, MSc
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Corresponding author

Correspondence to Chandrajit P. Raut MD, MSc.

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Morgan, E.A., Kozono, D.E., Wang, Q. et al. Cutaneous Radiation-Associated Angiosarcoma of the Breast: Poor Prognosis in a Rare Secondary Malignancy. Ann Surg Oncol 19, 3801–3808 (2012). https://doi.org/10.1245/s10434-012-2563-4

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  • DOI: https://doi.org/10.1245/s10434-012-2563-4

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