Radiation-associated angiosarcoma of the breast: consider chemotherapy

Radiation-associated angiosarcoma (RAAS) of the breast arises as a rare secondary effect of radiotherapy administered for breast cancer. The prognosis for RAAS is poorly understood, and surgical outcomes are often unsatisfactory. Our group investigated the impact of neoadjuvant chemotherapy (NAC) on RAAS. This study aims to refine prognostic factors and assess the effect of NAC on breast RAAS.

We analyzed M0 patients who underwent surgery for breast RAAS. Prognostic factors for overall survival (OS), time to distant progression (TTDP), and time to loco-regional progression (TTLP) were identified. Outcomes in patients receiving surgery alone (S) were compared to those receiving NAC followed by surgery (NAC + S) using Cox regression. Results were further validated through a propensity score model.

Out of 180 patients (179 women), 141 received S, and 39 received NAC + S. Median follow-up was 5.5 years. The 5-year OS rate was 50 %. Local recurrence occurred twice as often as metastases, with TTLP and TTDP rates of 68 % and 36 %, respectively. TTLP for patients treated with NAC + S and Swas 53 % vs. 30 % (p = 0.03), respectively. Both, treatment sequence (NAC + S vs. S) and age, independently predicted TTLP, a finding confirmed by the propensity score model.

For patients with breast RAAS, Neoadjuvant chemotherapy followed by surgery appears to offer superior local control compared to surgery alone, potentially enhancing quality of life.