Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Outcomes in Patients with Radiation-Associated Angiosarcomas of the Breast Following Surgery and Radiotherapy for Breast Cancer

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

Abstract

Background

Radiation-associated angiosarcoma (RAAS) is a devastating disease occasionally observed in breast cancer patients treated with radiation. Due to its rarity, our knowledge—of disease risk factors, epidemiology, treatment, and outcome—is extremely limited. Therefore, we sought to identify clinicopathologic factors associated with local and distant recurrence and disease-specific survival (DSS).

Methods

Radiation-associated angiosarcoma was defined as pathologically confirmed breast or chest wall angiosarcoma arising within a previously irradiated field. A comprehensive search of our institutional tumor registry (1/1/93 through 2/28/11) was used to identify patients (n = 95 females). Patient, original tumor, RAAS treatment, and outcome variables were retrospectively retrieved and assembled into a database.

Results

The median follow-up for all RAAS patients was 10.3 (range, 2.4–31.8) years. The latency period following radiation exposure ranged from 1.4 to 26 (median, 7) years. One-year and 5-year DSS rates were 93.5 and 62.6 %, respectively. Reduced risk of local recurrence was observed in patients who received chemotherapy (P = 0.0003). In multivariable analysis, size was found to be an independent predictor of adverse outcome (P = 0.015).

Conclusions

Our study demonstrates that RAAS exhibits high recurrence rates. It also highlights the need for well-designed, multicenter, clinical trials to inform the true utility of chemotherapy in this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cahan WG, et al. Sarcoma arising in irradiated bone; report of 11 cases. Cancer. 1948;1(1):3–29.

    Article  PubMed  CAS  Google Scholar 

  2. Arlen M, et al. Radiation-induced sarcoma of bone. Cancer. 1971;28(5):1087–99.

    Article  PubMed  CAS  Google Scholar 

  3. Majeski J, et al. Cutaneous angiosarcoma in an irradiated breast after breast conservation therapy for cancer: association with chronic breast lymphedema. J Surg Oncol. 2000;74(3):208–12; discussion 212–3.

    Google Scholar 

  4. Monroe AT, et al. Angiosarcoma after breast-conserving therapy. Cancer. 2003;97(8):1832–40.

    Article  PubMed  Google Scholar 

  5. Taghian A, et al. Long-term risk of sarcoma following radiation treatment for breast cancer. Int J Radiat Oncol Biol Phys. 1991;21(2):361–7.

    Article  PubMed  CAS  Google Scholar 

  6. Tahir M, et al. Radiation induced angiosarcoma a sequela of radiotherapy for breast cancer following conservative surgery. Int Semin Surg Oncol. 2006;3:26.

    Article  PubMed  CAS  Google Scholar 

  7. Vorburger SA, et al. Angiosarcoma of the breast. Cancer. 2005;104(12):2682–8.

    Article  PubMed  Google Scholar 

  8. Yap J, et al. Sarcoma as a second malignancy after treatment for breast cancer. Int J Radiat Oncol Biol Phys. 2002;52(5):1231–7.

    Article  PubMed  Google Scholar 

  9. West JG, et al. Risk of angiosarcoma following breast conservation: a clinical alert. Breast J. 2005;11(2):115–23.

    Article  PubMed  Google Scholar 

  10. Pierce SM, et al. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys. 1992;23(5):915–23.

    Article  PubMed  CAS  Google Scholar 

  11. Kirova YM, et al. Radiation-induced sarcomas after radiotherapy for breast carcinoma: a large-scale single-institution review. Cancer. 2005;104(4):856–63.

    Article  PubMed  Google Scholar 

  12. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  13. Cox DR. Regression models and life tables. J R Stat Soc B. 1972;34:187–220.

    Google Scholar 

  14. Billings SD, et al. Cutaneous angiosarcoma following breast-conserving surgery and radiation: an analysis of 27 cases. Am J Surg Pathol. 2004;28(6):781–8.

    Article  PubMed  Google Scholar 

  15. Brenn T, Fletcher CD. Radiation-associated cutaneous atypical vascular lesions and angiosarcoma: clinicopathologic analysis of 42 cases. Am J Surg Pathol. 2005;29(8):983–96.

    PubMed  Google Scholar 

  16. Hui A, et al. Angiosarcoma of the breast: a difficult surgical challenge. Breast. 2012;21(4):584–9.

    Article  PubMed  Google Scholar 

  17. Scow JS, et al. Primary and secondary angiosarcoma of the breast: the Mayo Clinic experience. J Surg Oncol. 2010;101(5):401–7.

    PubMed  Google Scholar 

  18. Brady MS, et al. Post-treatment sarcoma in breast cancer patients. Ann Surg Oncol. 1994;1(1):66–72.

    Article  PubMed  CAS  Google Scholar 

  19. Weatherby RP, et al. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases. Mayo Clin Proc. 1981;56(5):294–306.

    PubMed  CAS  Google Scholar 

  20. Inoue YZ, et al. Clinicopathologic features and treatment of postirradiation sarcoma of bone and soft tissue. J Surg Oncol. 2000;75(1):42–50.

    Article  PubMed  CAS  Google Scholar 

  21. Manner J, et al. MYC high level gene amplification is a distinctive feature of angiosarcomas after irradiation or chronic lymphedema. Am J Pathol. 2010;176(1):34–9.

    Article  PubMed  CAS  Google Scholar 

  22. Hadj-Hamou NS, et al. A transcriptome signature distinguished sporadic from postradiotherapy radiation-induced sarcomas. Carcinogenesis. 2011;32(6):929–34.

    Article  PubMed  CAS  Google Scholar 

  23. de Jong MA, et al. Reirradiation and hyperthermia for radiation-associated sarcoma. Cancer. 2012;118(1):180–7.

    Article  PubMed  Google Scholar 

  24. Palta M, et al. Angiosarcoma after breast-conserving therapy: long-term outcomes with hyperfractionated radiotherapy. Cancer. 2010;116(8):1872–8.

    Article  PubMed  Google Scholar 

  25. Riad S, et al. The clinical and functional outcome for patients with radiation-induced soft tissue sarcoma. Cancer. 2012;118(10):2682–92.

    Article  PubMed  Google Scholar 

  26. Gladdy RA, et al. Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas? J Clin Oncol. 2010;28(12):2064–9.

    Article  PubMed  Google Scholar 

  27. Rao J, et al. Cutaneous angiosarcoma as a delayed complication of radiation therapy for carcinoma of the breast. J Am Acad Dermatol. 2003;49(3):532–8.

    Article  PubMed  Google Scholar 

  28. Fury MG, et al. A 14-year retrospective review of angiosarcoma: clinical characteristics, prognostic factors, and treatment outcomes with surgery and chemotherapy. Cancer J. 2005;11(3):241–7.

    Article  PubMed  Google Scholar 

  29. Strobbe LJ, et al. Angiosarcoma of the breast after conservation therapy for invasive cancer, the incidence and outcome. An unforseen sequela. Breast Cancer Res Treat. 1998;47(2):101–9.

    Article  PubMed  CAS  Google Scholar 

  30. Pisters PW, et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14(5):1679–89.

    PubMed  CAS  Google Scholar 

  31. Zagars GK, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97(10):2530–43.

    Article  PubMed  Google Scholar 

  32. Yang JC, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.

    PubMed  CAS  Google Scholar 

  33. Cantin J, et al. The problem of local recurrence after treatment of soft tissue sarcoma. Ann Surg. 1968;168(1):47–53.

    Article  PubMed  CAS  Google Scholar 

  34. Gerner RE, et al. Soft tissue sarcomas. Ann Surg. 1975;181(6):803–8.

    Article  PubMed  CAS  Google Scholar 

  35. Abbas JS, et al. The surgical treatment and outcome of soft-tissue sarcoma. Arch Surg. 1981;116(6):765–9.

    Article  PubMed  CAS  Google Scholar 

  36. Georgiannos SN, Sheaff M. Angiosarcoma of the breast: a 30 year perspective with an optimistic outlook. Br J Plast Surg. 2003;56(2):129–34.

    Article  PubMed  CAS  Google Scholar 

  37. Penel N, et al. Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX Study. J Clin Oncol. 2008;26(32):5269–74.

    Article  PubMed  CAS  Google Scholar 

  38. Casper ES, et al. Phase II trial of paclitaxel in patients with soft-tissue sarcoma. Cancer Invest. 1998;16(7):442–6.

    Article  PubMed  CAS  Google Scholar 

  39. Fata F, et al. Paclitaxel in the treatment of patients with angiosarcoma of the scalp or face. Cancer. 1999;86(10):2034–7.

    Article  PubMed  CAS  Google Scholar 

  40. Mano MS, et al. Radiation-induced angiosarcoma of the breast shows major response to docetaxel after failure of anthracycline-based chemotherapy. Breast. 2006;15(1):117–8.

    Article  PubMed  Google Scholar 

  41. Perez-Ruiz E, et al. Response to paclitaxel in a radiotherapy-induced breast angiosarcoma. Acta Oncol. 2009;48(7):1078–9.

    Article  PubMed  CAS  Google Scholar 

  42. Nakamura M, et al. Angiosarcoma with sacral origin metastasizing to the lung. Intern Med. 2006;45(15):923–6.

    Article  PubMed  Google Scholar 

  43. Gambini D, et al. Paclitaxel-dependent prolonged and persistent complete remission four years from first recurrence of secondary breast angiosarcoma. Tumori. 2009;95(6):828–31.

    PubMed  Google Scholar 

  44. Lahat G, et al. Angiosarcoma: clinical and molecular insights. Ann Surg. 2010;251(6):1098–106.

    Article  PubMed  Google Scholar 

  45. Lahat G, et al. Outcome of locally recurrent and metastatic angiosarcoma. Ann Surg Oncol. 2009;16(9):2502–9.

    Article  PubMed  CAS  Google Scholar 

  46. Nagano T, et al. Docetaxel: a therapeutic option in the treatment of cutaneous angiosarcoma: report of 9 patients. Cancer. 2007;110(3):648–51.

    Article  PubMed  CAS  Google Scholar 

  47. Silverman LR, et al. Chemotherapy for angiosarcoma of the breast: case report of 30-year survival and analysis of the literature. Cancer Invest. 1994;12(2):145–55.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We thank Sarah Taylor for generous assistance in the identification of cases. This work was supported in part by the Sarcoma Alliance for Research through Collaboration.

Disclosures

There are no conflicts of interest with any financial organization regarding the material discussed in this article.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    Keila E. Torres MD, PhD, Min Yi MD, PhD, Kelly K. Hunt MD, Janice N. Cormier MD, MPH, Barry W. Feig MD & Raphael E. Pollock MD, PhD

  2. Sarcoma Research Center, UT MD Anderson Cancer Center, Houston, TX, USA

    Keila E. Torres MD, PhD, Katherine Kin BS, Caitlin D. May BS, Ryan Lam BS, Guy Lahat MD, Aviad Hoffman MD, Alexander J. Lazar MD, PhD, Dina Lev MD & Raphael E. Pollock MD, PhD

  3. Department of Sarcoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    Vinod Ravi MD

  4. Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    B. Ashleigh Guadagnolo MD, MPH

  5. Department of Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    Banu K. Arun MD

  6. Department of Pathology, UT MD Anderson Cancer Center, Houston, TX, USA

    Alexander J. Lazar MD, PhD

  7. Department of Cancer Biology, UT MD Anderson Cancer Center, Houston, TX, USA

    Dina Lev MD

Authors
  1. Keila E. Torres MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vinod Ravi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine Kin BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Min Yi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Ashleigh Guadagnolo MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caitlin D. May BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Banu K. Arun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kelly K. Hunt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ryan Lam BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Guy Lahat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Aviad Hoffman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Janice N. Cormier MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Barry W. Feig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Alexander J. Lazar MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Dina Lev MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Raphael E. Pollock MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keila E. Torres MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Torres, K.E., Ravi, V., Kin, K. et al. Long-Term Outcomes in Patients with Radiation-Associated Angiosarcomas of the Breast Following Surgery and Radiotherapy for Breast Cancer. Ann Surg Oncol 20, 1267–1274 (2013). https://doi.org/10.1245/s10434-012-2755-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2755-y

Keywords

Search

Navigation