Radiation-Induced Angiosarcoma of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Radiation-induced angiosarcoma:
    • Is extremely rare and is seen in less than 1% of patients who receive radiotherapy for breast cancer
  • Polgár et al:
    • Found an incidence of 0.46 per 1,000 cases at their institution
    • Radiation-induced angiosarcoma:
      • Was associated with a latency period of 6 to 8 years in that study
    • Additional studies have demonstrated an interval of 3 to 12 years:
      • With a median time to development of 6 years
    • Presentation often includes:
      • A bruise-like appearance in the treated region:
        • So a high index of suspicion is needed to make the diagnosis
  • Treatment includes:
    • Surgery with or without radiation:
      • But radiation is not contraindicated
  • Smith et al. treated patients with hyperfractionated accelerated re-irradiation therapy with or without surgery:
    • Utilizing three radiation therapy treatments each day:
      • With a minimum interfraction interval of 4 hours, 5 days a week:
        • At 1 Gy per fraction, to total doses of 45 Gy, 60 Gy, and 75 Gy for areas with a moderate risk for subclinical disease, a high risk for subclinical disease, and gross disease, respectively
    • Toxicity was minimal
    • Median survival was 7 years:
      • 10-year cause specific was 71%
    • These numbers are better than the 5-year overall survival of 40% and local control rates of approximately 30% reported by Depla et al
  • References
    • Abbott R, Palmieri C. Angiosarcoma of the breast following surgery and radiotherapy for breast cancer. Nat Clin Pract Oncol. 2008;5(12):727-736.
    • Polgár C, Orosz Z, Szerdahelyi A, et al. Postirradiation angiosarcoma of the chest wall and breast: issues of radiogenic origin, diagnosis, and treatment in two cases. Oncology. 2001;60(1):31-34.
    • Smith TL, Morris CG, Mendenhall NP. Angiosarcoma after breast-conserving therapy: long-term disease control and late effects with hyperfractionated accelerated re-irradiation (HART). Acta Oncol. 2014;53(2):235-241.
    • Koerner F. Sarcoma. In: Hoda S, Brogi E, Koerner F, Rosen PP, eds. Rosen’s Breast Pathology. 4th ed. Philadelphia, PA: LWW, Wolters Klumer; 2014:1118–1126.
    • Depla AL, Scharloo-Kareis CH, de Jong MA, et al. Treatment and prognostic factors of radiation- associated angiosarcoma (RAAS) after primary breast cancer: a systematic review. Eur J Cancer. 2014;50(1):1779-1788.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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