Angiosarcoma of the breast: a difficult surgical challenge

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Breast angiosarcoma is a rare malignancy with diverse origins, including post-radiation, chronic lymphedema, and primary development.
• The Peter MacCallum Cancer Centre possesses extensive experience in managing breast and sarcoma cases, including radiotherapy.

Purpose of the Study:

• To evaluate the management strategies and locoregional and distant outcomes for patients with breast angiosarcoma.
• To analyze presentation, treatment, and survival rates for primary and secondary breast angiosarcoma.

Main Methods:

• Retrospective analysis of patients diagnosed with primary or secondary breast angiosarcoma between 2000 and 2010.
• Review of prospective breast and sarcoma databases to extract data on presentation, management, recurrence, and survival.

Main Results:

• Eight cases of secondary breast angiosarcoma occurred after breast-conserving surgery with radiotherapy, with a median latency of 7 years.
• Seven local recurrences and seven instances of distant metastasis were observed among the patients, with two deaths attributed to distant disease.
• All patients underwent total mastectomy, with five requiring autologous tissue transfer; adjuvant radiotherapy and paclitaxel were administered in some cases.

Conclusions:

• Primary angiosarcoma presents as a breast mass, while secondary angiosarcoma often appears as a skin lesion post-radiotherapy for breast conservation.
• Breast angiosarcoma management remains complex, characterized by poor locoregional and distant disease control.
• Secondary angiosarcoma is an iatrogenic condition necessitating vigilant follow-up and judicious application of radiotherapy in breast-conserving treatments.