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Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall

Wirkung einer Kombination aus chirurgischer Therapie, erneuter Bestrahlung und Hyperthermie auf die lokale Kontrollrate bei strahleninduzierten Angiosarkomen der Brustwand

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Abstract

Purpose

Radiation-induced angiosarcoma (RAS) of the chest wall/breast has a poor prognosis due to the high percentage of local failures. The efficacy and side effects of re-irradiation plus hyperthermia (reRT + HT) treatment alone or in combination with surgery were assessed in RAS patients.

Patients and methods

RAS was diagnosed in 23 breast cancer patients and 1 patient with melanoma. These patients had previously undergone breast conserving therapy (BCT, n = 18), mastectomy with irradiation (n=5) or axillary lymph node dissection with irradiation (n = 1). Treatment consisted of surgery followed by reRT + HT (n = 8), reRT + HT followed by surgery (n = 3) or reRT + HT alone (n = 13). Patients received a mean radiation dose of 35 Gy (32–54 Gy) and 3–6 hyperthermia treatments (mean 4). Hyperthermia was given once or twice a week following radiotherapy (RT).

Results

The median latency interval between previous radiation and diagnosis of RAS was 106 months (range 45–212 months). Following reRT + HT, the complete response (CR) rate was 56 %. In the subgroup of patients receiving surgery, the 3-month, 1- and 3-year actuarial local control (LC) rates were 91, 46 and 46 %, respectively. In the subgroup of patients without surgery, the rates were 54, 32 and 22 %, respectively. Late grade 4 RT toxicity was seen in 2 patients.

Conclusion

The present study shows that reRT + HT treatment—either alone or combined with surgery—improves LC rates in patients with RAS.

Zusammenfassung

Ziel

Das strahleninduzierte Angiosarkom (RAS, „radiation-induced angiosarcoma“) der Brustwand hat wegen des hohen Anteils an lokalem Versagen eine schlechte Prognose. Die Wirksamkeit und Nebenwirkungen von Rebestrahlung und Hyperthermie (ReRT + HT) allein oder in Kombination mit vorhergehender oder nachfolgender Operation wurden bei Patienten mit einem RAS der Brustwand überprüft

Patienten und Methoden

RAS wurde bei 23 Patientinnen mit Brustkrebs und bei einer Patientin mit malignem Melanom, nach früherer brusterhaltender Brustkrebstherapie (n=18), Mastektomie mit Bestrahlung (n=5) und axillärer Lymphknotendissektion mit Bestrahlung (n=1) diagnostiziert. Die Behandlung des RAS bestand aus Chirurgie gefolgt von ReRT + HT (n=8), ReRT + HT gefolgt von Chirurgie (n=3) oder ReRT + HT allein (n=13). Die Patienten wurden mit einer Strahlendosis von 32–54 Gy behandelt (durchschnittlich 35 Gy) und 3–6 Hyperthermiebehandlungen (durchschnittlich 4). Die Hyperthermie wurde 1-mal oder 2-mal pro Woche nach der Bestrahlung gegeben.

Ergebnisse

Das durchschnittliche Latenzzeitintervall zwischen ehemaliger Bestrahlung und RAS-Diagnose betrug 106 Monate (Bereich 45–212 Monate). Nach ReRT + HT lag die komplette Remission (CR) bei 56%. In der Untergruppe von Patienten mit Chirurgie lagen die 3-Monats-, 1- und 3-Jahres-Lokalkontrollraten (LC) bei 91%, 46% und 46%. In der Untergruppe von Patienten ohne Operation waren dies 54%, 32% und 22%. Eine Grad-4-Spättoxizität zeigte sich bei 2 Patienten.

Schlussfolgerung

Die vorliegende Studie zeigt, dass ReRT + HT entweder allein oder in Kombination mit Chirurgie zu einer verbesserten LC-Rate bei Patienten mit RAS führt.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC-Daniel den Hoed Cancer Center, 3008, Rotterdam, The Netherlands

    M. Linthorst MD., G.C. van Rhoon Ph.D. & J. van der Zee M.D., Ph.D.

  2. Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, 3008, Rotterdam, The Netherlands

    A.N. van Geel M.D., Ph.D

  3. Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, 3008, Rotterdam, The Netherlands

    E.A. Baartman M.D.

  4. Department of Radiation Oncology, Bernard Verbeeten Institute, 5000, Tilburg, The Netherlands

    S.B. Oei M.D.

  5. Department of Trial and Medical Statistics, Erasmus MC-Daniel den Hoed Cancer Center, 3008, Rotterdam, The Netherlands

    W. Ghidey Ph.D.

Authors
  1. M. Linthorst MD.
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  2. A.N. van Geel M.D., Ph.D
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  3. E.A. Baartman M.D.
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  4. S.B. Oei M.D.
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  6. G.C. van Rhoon Ph.D.
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  7. J. van der Zee M.D., Ph.D.
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Correspondence to M. Linthorst MD..

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Linthorst, M., van Geel, A., Baartman, E. et al. Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall. Strahlenther Onkol 189, 387–393 (2013). https://doi.org/10.1007/s00066-013-0316-3

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