Radiation-induced angiosarcoma of the breast: A review

Angiosarcoma is a rare, aggressive malignant vascular neoplasm with poor prognosis that has a predilection for skin and superficial soft tissue. It can arise spontaneously or in association with factors like chronic lymphedema or radiation therapy. Radiotherapy used to treat invasive breast tumors is a known risk factor for the development of the so-called radiation-induced angiosarcoma (RIAS), a condition that has been described in the literature with increasing frequency. Radiation-induced angiosarcoma of the breast usually arises on the previously irradiated skin area several years after radiotherapy and presents as painless multifocal erythematous patches or plaques similar to a hematoma. Cutaneous biopsy is essential for the diagnosis. Histologically, RIAS is characterized by irregular anastomosing vessels lined by endothelial cells showing nuclear atypia. Treatment is mostly surgical, and mastectomy with negative margins is considered the standard procedure. However, recurrences are common, and an approach combining surgery, chemo- and radiotherapy may be more effective. The purpose of this study is to review the most recent medical literature on RIAS of the breast, with emphasis on its pathophysiology, clinical and histological features and current treatment options.