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Wong HH, Cojocaru E, Watkins J, James S, Aloysius T, Harrington J, Horan G, Hatcher H. Radiation-induced angiosarcoma of the breast: retrospective analysis at a regional treatment centre. Breast Cancer 2024; 31:272-282. [PMID: 38147173 DOI: 10.1007/s12282-023-01535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer. METHODS Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England. RESULTS 22 patients were identified between 2010 and 2022. Median age of diagnosis was 65 years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5 years (range 2.4-16.0)-this interval has decreased over the last 24 years (r2 = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28 months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65 months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72 years had a median OS of 45 months vs 102 months for those ≤ 72 years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086). CONCLUSION RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.
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Affiliation(s)
- Han Hsi Wong
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Elena Cojocaru
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - James Watkins
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sujil James
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Tony Aloysius
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Jennifer Harrington
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Gail Horan
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Helen Hatcher
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
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Pasteris A, Pili N, Nonnis R, Marras V, Patetta R, Cossu A, Rubino C. A rare case of radiation-induced breast angiosarcoma: a case report. Case Reports Plast Surg Hand Surg 2023; 11:2296697. [PMID: 38179209 PMCID: PMC10763889 DOI: 10.1080/23320885.2023.2296697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
We describe a rare case of a 77-year-old woman with radiation-induced breast angiosarcoma (RIAS) in whom radical surgery with negative margins determined that at 14-month of follow-up there is no evidence of either local or systemic recurrence without having to resort to adjuvant chemotherapy.
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Affiliation(s)
- Andrea Pasteris
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Nicola Pili
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Rita Nonnis
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | | | - Antonio Cossu
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
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3
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Sato F, Yamamoto T. Breast Angiosarcoma after Primary Breast Cancer Surgery: A Systematic Review. J Plast Reconstr Aesthet Surg 2022; 75:2882-2889. [DOI: 10.1016/j.bjps.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
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Verdura V, Di Pace B, Concilio M, Guastafierro A, Fiorillo G, Alfano L, Nicoletti GF, Savastano C, Cascone AM, Rubino C. A new case of radiation-induced breast angiosarcoma. Int J Surg Case Rep 2019; 60:152-155. [PMID: 31228777 PMCID: PMC6597493 DOI: 10.1016/j.ijscr.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/25/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022] Open
Abstract
A biopsy of any suspicious breast skin lesion after radiotherapy is recommended. Patients with clinical anomalies post-breast cancer surgery and RT need attention. The Angiosarcoma was cured due to surgery and high-dose neoadjuvant chemotherapy. A correct 6 month follow-up is needed: check-ups, chest X-rays and ultrasound. The survival of the patient suggests possible ways to manage this rare tumour type.
Introduction Radiation-induced breast angiosarcoma is a severe but rare late complication in the breast-preserving management of breast cancer through surgery and radiotherapy. Often the initial diagnosis is complex given its relatively anodyne nature and the fact that it usually presents in the form of typically multifocal reddish-purple papular skin lesions. Presentation of the case We describe the clinical and pathologic findings of a 79-year-old woman, who developed a radiation-induced breast angiosarcoma after around 8 years. She initially refused a mastectomy leading to an adaptation in the management of this cancer. Discussion The average latency of secondary angiosarcoma of the breast following radiation therapy is around six years. Breast angiosarcoma is typically considered to affect the dermis, and is therefore cutaneous in origin. An incisional biopsy of the discoloured skin and underlying mass is necessary. The treatment is surgical resection. The role of chemotherapy has not been clearly defined. Most data originate from retrospective case series studies suggesting that angiosarcomas are relatively sensitive to taxanes and anthracyclines. Conclusion The preferred treatment is always aggressive surgical removal and, as our atypical clinical case suggests, neoadjuvant chemotherapy in very high doses is also needed. A biopsy of any suspicious breast skin lesion after radiotherapy is recommended. Despite the treatment challenges, our case provides enlightening details on the management of such a rare cancer even when faced with unplanned events which do not always allow for a textbook approach.
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Affiliation(s)
- Vincenzo Verdura
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Bruno Di Pace
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" PhD School in Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | - Marina Concilio
- Department of Medicine, Surgery and Dentistry, Plastic Surgery Unit, Università degli Studi di Salerno, Salerno, Italy
| | - Antonio Guastafierro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Fiorillo
- A.O.U. San Giovanni di Dio e Ruggi D'Aragona, via San Leonardo, Salerno, Italy
| | - Luigi Alfano
- A.O.U. San Giovanni di Dio e Ruggi D'Aragona, via San Leonardo, Salerno, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Anna Maria Cascone
- A.O.U. San Giovanni di Dio e Ruggi D'Aragona, via San Leonardo, Salerno, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Dentistry, Plastic Surgery Unit, Università degli Studi di Salerno, Salerno, Italy; Plastic Surgery Unit, Department of Surgery, Microsurgery and Medical Sciences, University Hospital Trust, Università degli Studi di Sassari, Sassari, Italy
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Horisawa N, Adachi Y, Sawaki M, Hattori M, Yoshimura A, Gondo N, Kotani H, Kataoka A, Sugino K, Mori M, Terada M, Ozaki Y, Iwata H. A case of radiation-associated angiosarcoma after breast cancer. Surg Case Rep 2018; 4:131. [PMID: 30406473 PMCID: PMC6221852 DOI: 10.1186/s40792-018-0538-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Radiation-associated angiosarcoma (RAAS) is a rare subtype of secondary angiosarcoma that is characterized by rapid proliferation and extensive tissue infiltration. Although various treatments for RAAS (such as surgery, chemotherapy, and radiation therapy) have been reported, there is no consensus as to which approach is the best. CASE PRESENTATION A 76-year-old woman presented with right breast cancer (T1N0M0, stage I) 9 years ago. She had undergone breast-conserving surgery and sentinel lymph node biopsy and was receiving adjuvant chemotherapy and radiation therapy for the malignancy. Six years after presenting with the tumor, she developed pigmented skin and was diagnosed with a RAAS; this angiosarcoma recurred three times within 2 years. The angiosarcoma was resected each of the three times, after which adjuvant radiation therapy was performed. At 76 years old, the patient developed a new mass on her chest skin in the vicinity of the scar. Angiosarcoma was diagnosed following a pathology report, which resulted in a second diagnosis of recurrent RAAS again since the diagnostic criteria were met. After extensive resection of the irradiated area, the patient has remained free of angiosarcoma for the last 3 years. CONCLUSION Resection of the entire irradiated field is critical for successful treatment of RAAS.
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Affiliation(s)
- Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Naomi Gondo
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Makiko Mori
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Mitsuo Terada
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Yuri Ozaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, chikusa-ku, Nagoya, Aichi 〒464-8681 Japan
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Demoor-Goldschmidt C, Mahé MA, Supiot S. Breast lymphoma occurring after an invasive ductal breast carcinoma developed in the same area: A case report and literature review. Cancer Radiother 2018; 22:167-170. [PMID: 29657120 DOI: 10.1016/j.canrad.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 10/17/2022]
Abstract
Chemo- and radiotherapy are treatments very helpful to cure cancers but are also well known for adverse effects such as secondary cancers. Breast cancers following Hodgkin lymphoma have been relatively well studied. Breast cancers after radiotherapy covering or nearby breasts or nipples are usually carcinomas or secondary sarcomas. Among the big cohort of patients treated for breast carcinomas, breast lymphomas developed in the same area are not usual. Nevertheless, published studies described a significant increased risk of non-Hodgkin lymphoma after initial radiotherapy for a solid cancer. Here, we report a case of a secondary breast lymphoma observed in a 53-year-old woman treated 13 years before for a ductal carcinoma and analyse such second tumors with a review of the literature. This case report emphasizes the importance of the biopsy in case of recurrence in breast cancer to give the appropriate treatment.
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Affiliation(s)
- C Demoor-Goldschmidt
- Integrated Center of Oncology, Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France; Inserm UMR 1018, centre de recherche en épidémiologie et santé des populations, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Institut Gustave-Roussy, B2M, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - M-A Mahé
- Integrated Center of Oncology, Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France; Inserm UMR892, 8, quai Moncousu, 44007 Nantes, France
| | - S Supiot
- Integrated Center of Oncology, Institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France; Inserm UMR892, 8, quai Moncousu, 44007 Nantes, France
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Iacoponi S, Calleja J, Hernandez G, Sainz de la Cuesta R. Primary breast angiosarcoma in a young woman. Int J Surg Case Rep 2016; 24:101-3. [PMID: 27232295 PMCID: PMC4885116 DOI: 10.1016/j.ijscr.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022] Open
Abstract
Angiosarcomas are rare malignant vascular tumors of the breast. They frequently are associated with previous breast radiotherapy. Total mastectomy without axillary lymphadenectomy appears to be the only treatment. Chemotherapy and radiotherapy have not proven any benefit in terms of survival.
Introduction Angiosarcomas of the breast are a rare subtype of sarcomas that frequently are diagnosed after radiation therapy for primary breast cancer. Primary angiosarcomas are rare entities accounting 0.05% of all malignant breast neoplasm. Presentation of Case We report a case of primary angiosarcoma of the breast in a 25 years woman, with no previous radiotherapy, treated with a total mastectomy followed by radio-chemotherapy. Discussion Total mastectomy appears to be the only treatment known that has proven to benefit these patients. Adjuvant treatment has not proven value up until today. The 5-year disease free survival for grade 1 tumors can be as high as 76%, and up to 15% for grade 3. Conclusion Due to the rarity of these tumors there is no standard therapies approach.
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Affiliation(s)
- Sara Iacoponi
- Gynecologic Oncology Unit. Quiron university hospital Madrid, Spain.
| | - Jackie Calleja
- Gynecologic Oncology Unit. Quiron university hospital Madrid, Spain
| | - Gines Hernandez
- Gynecologic Oncology Unit. Quiron university hospital Madrid, Spain
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Grebić D, Tomašić AM. Sporadic Case of Breast Angiosarcoma as a Complication of Radiotherapy Following Breast-Conserving Surgery for Invasive Ductal Breast Cancer. Breast Care (Basel) 2015; 10:336-8. [PMID: 26688682 DOI: 10.1159/000437071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Angiosarcomas are highly aggressive and malignant blood vessel tumors. Rarely, angiosarcomas develop in the breast following conservative therapy, namely radiotherapy. CASE REPORT A 70-year-old female patient presented with dark purple discoloration of the skin of the right breast. 6 years earlier, the patient had undergone conservative surgery for invasive ductal carcinoma of the right breast. According to the breast-conserving surgery protocol, the patient had been treated with radiotherapy to the residual breast tissue. The patient's annual mammograms and ultrasound findings were normal. The skin lesion was superficially localized mostly at the border between the upper and lower medial quadrants of the breast (between 2 and 4 o'clock) and above the areola. The borders were uneven; the dimensions were 7 cm × 4 cm. The mammogram was classified as Breast Imaging Report and Data System (BI-RADS) 2. Ultrasound examination showed a well-vascularized structure, although the etiology was unclear. A tissue biopsy revealed angiosarcoma. The patient underwent radical simplex mastectomy. Following surgery, the patient underwent chemotherapy. Tests excluded metastases for a follow-up period of 5 years. CONCLUSION Angiosarcomas that develop after radiotherapy following breast-conserving surgery are sporadic, but it is important to take this possible incident into consideration during treatment.
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Affiliation(s)
- Damir Grebić
- Department of Surgery, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Croatia
| | - Ana Marija Tomašić
- Integrated Undergraduate and Graduate Medical Program, School of Medicine, University of Rijeka, Croatia
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Baer LN, Savage DG, Hibshoosh HH, Kalinsky K. Concomitant angiosarcoma and lymphoproliferative disorder in solid organ transplant recipients. Clin Sarcoma Res 2014; 4:15. [PMID: 25400905 PMCID: PMC4233048 DOI: 10.1186/2045-3329-4-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/13/2014] [Indexed: 01/15/2023] Open
Abstract
An increased risk of posttransplant malignancy has been consistently reported following various solid organ transplants. The malignancies most commonly encountered are non-melanoma skin cancers, carcinomas of lung or breast and posttransplant lymphoproliferative disorders. Angiosarcoma, an uncommon vascular mesenchymal neoplasm, is rare in the posttransplant setting. This report describes two patients who developed high-grade angiosarcoma following a solid organ transplant. Notably, in both patients, the diagnosis of angiosarcoma was preceded by diagnosis of a lymphoproliferative disorder with monoclonal immunoglobulin heavy chain rearrangement.
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Affiliation(s)
- Lea N Baer
- Division of Hematology and Oncology, Stony Brook Medicine, New York, NY USA
| | - David G Savage
- Division of Hematology and Oncology, New York- Presbyterian, New York, NY USA
| | | | - Kevin Kalinsky
- Division of Hematology and Oncology, New York- Presbyterian, New York, NY USA
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Bell RJ. Screening mammography--early detection or over-diagnosis? Contribution from Australian data. Climacteric 2014; 17 Suppl 2:66-72. [PMID: 25224048 DOI: 10.3109/13697137.2014.956718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this review was to examine the benefits and harms of organized screening mammography, with particular reference to data from Australia. METHODS Published literature was examined relating to the impact of screening mammography on breast cancer-specific mortality, the trends in use of adjuvant treatments for breast cancer, the effectiveness of adjuvant treatment in terms of breast cancer-specific mortality, the impact of breast cancer treatment on non-breast cancer mortality and the magnitude of the issue of over-diagnosis. RESULTS Most of the recent reduction in breast cancer-specific mortality is explained by use of adjuvant therapy rather than screening mammography. The impact of screening mammography in countries where women present with early disease and have access to adjuvant treatment is modest. There is a wide range of estimates for the magnitude of over-diagnosis. All-cause mortality (rather than breast cancer-specific mortality) should be used when assessing the impact of mammographic screening as otherwise the harm of breast cancer treatment in women who are over-diagnosed will be missed. CONCLUSIONS The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.
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Affiliation(s)
- R J Bell
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine , Melbourne, Victoria , Australia
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11
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Crowley TP, Sainsbury DCG, Crowley DM, Milner RH, Ragbir M. The surgical management of angiosarcoma of the breast—a single institution experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sporadic versus Radiation-Associated Angiosarcoma: A Comparative Clinicopathologic and Molecular Analysis of 48 Cases. Sarcoma 2013; 2013:798403. [PMID: 24082817 PMCID: PMC3776386 DOI: 10.1155/2013/798403] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022] Open
Abstract
Angiosarcomas are aggressive tumors of vascular endothelial origin, occurring sporadically or in association with prior radiotherapy. We compared clinicopathologic and biologic features of sporadic angiosarcomas (SA) and radiation-associated angiosarcomas (RAA). Methods. From a University of Michigan institutional database, 37 SA and 11 RAA were identified. Tissue microarrays were stained for p53, Ki-67, and hTERT. DNA was evaluated for TP53 and ATM mutations. Results. Mean latency between radiotherapy and diagnosis of RAA was 11.9 years: 6.7 years for breast RAA versus 20.9 years for nonbreast RAA (P = 0.148). Survival after diagnosis did not significantly differ between SA and RAA (P = 0.590). Patients with nonbreast RAA had shorter overall survival than patients with breast RAA (P = 0.03). The majority of SA (86.5%) and RAA (77.8%) were classified as high-grade sarcomas (P = 0.609). RAA were more likely to have well-defined vasoformative areas (55.6% versus 27%, P = 0.127). Most breast SA were parenchymal in origin (80%), while most breast RAA were cutaneous in origin (80%). TMA analysis showed p53 overexpression in 25.7% of SA and 0% RAA, high Ki-67 in 35.3% of SA and 44.4% RAA, and hTERT expression in 100% of SA and RAA. TP53 mutations were detected in 13.5% of SA and 11.1% RAA. ATM mutations were not detected in either SA or RAA. Conclusions. SA and RAA are similar in histology, immunohistochemical markers, and DNA mutation profiles and share similar prognosis. Breast RAA have a shorter latency period compared to nonbreast RAA and a significantly longer survival.
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14
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Secondary breast angiosarcoma and germ line BRCA mutations: discussion of genetic susceptibility. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13566-013-0096-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Torres KE, Ravi V, Kin K, Yi M, Guadagnolo BA, May CD, Arun BK, Hunt KK, Lam R, Lahat G, Hoffman A, Cormier JN, Feig BW, Lazar AJ, Lev D, Pollock RE. Long-term outcomes in patients with radiation-associated angiosarcomas of the breast following surgery and radiotherapy for breast cancer. Ann Surg Oncol 2012; 20:1267-74. [PMID: 23224828 DOI: 10.1245/s10434-012-2755-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Keila E Torres
- Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA.
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Sheth GR, Cranmer LD, Smith BD, Grasso-LeBeau L, Lang JE. Radiation-induced sarcoma of the breast: a systematic review. Oncologist 2012; 17:405-18. [PMID: 22334455 PMCID: PMC3316927 DOI: 10.1634/theoncologist.2011-0282] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/30/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Radiation-induced sarcoma (RIS) is a rare, aggressive malignancy. Breast cancer survivors treated with radiotherapy constitute a large fraction of RIS patients. To evaluate evidenced-based practices for RIS treatment, we performed a systematic review of the published English-language literature. METHODS We performed a systematic keyword search of PubMed for original research articles pertaining to RIS of the breast. We classified and evaluated the articles based on hierarchical levels of scientific evidence. RESULTS We identified 124 original articles available for analysis, which included 1,831 patients. No randomized controlled trials involving RIS patients were found. We present the best available evidence for the etiology, comparative biology to primary sarcoma, prognostic factors, and treatment options for RIS of the breast. CONCLUSION Although the evidence to guide clinical practice is limited to single institutional cohort studies, registry studies, case-control studies, and case reports, we applied the available evidence to address clinically relevant questions related to best practice in patient management. Surgery with widely negative margins remains the primary treatment of RIS. Unfortunately, the role of adjuvant and neoadjuvant chemotherapy remains uncertain. This systematic review highlights the need for additional well-designed studies to inform the management of RIS.
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Affiliation(s)
- Grishma R. Sheth
- Department of Surgery, Division of Surgical Oncology
- Arizona Cancer Center
| | - Lee D. Cranmer
- Arizona Cancer Center
- Department of Medicine, Division of Hematology-Oncology, and
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Julie E. Lang
- Department of Surgery, Division of Surgical Oncology
- Arizona Cancer Center
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Kayaci S, Yildiz O, Gucer H, Mandel NM. Angiosarcoma of the liver with metastasis to the cervical spine cured with the treatment of thalidomide and radiotherapy. Acta Neurochir (Wien) 2012; 154:369-70. [PMID: 21997379 DOI: 10.1007/s00701-011-1192-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
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Kalli S, Freer PE, Rafferty EA. Lesions of the skin and superficial tissue at breast MR imaging. Radiographics 2011; 30:1891-913. [PMID: 21057126 DOI: 10.1148/rg.307105064] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although numerous studies have outlined the benefits of contrast material-enhanced magnetic resonance (MR) imaging for the detection of breast parenchymal findings, the assessment of lesions of the skin and superficial tissue at breast MR imaging has largely been overlooked. Such lesions, both benign and malignant, are commonly encountered at breast MR imaging, and their detection and diagnosis are often imperative. These lesions include superficial, locally extensive, inflammatory, and recurrent breast cancers; iatrogenic changes; sebaceous cysts; and less prevalent diseases such as granulomatous mastitis and angiosarcomas, among others. As MR imaging continues to be used with increasing frequency in both the screening and diagnostic settings, these lesions will be encountered more often; consequently, a better understanding of which lesions may be ignored and which require further evaluation will become increasingly important. Frequently, MR imaging alone may not clearly indicate the cause of lesions of the breast skin and superficial tissue. However, radiologists should thoroughly assess such lesions, taking into consideration the spectrum of possible causes. Mammography, ultrasonography, consultation with clinicians or dermatologists regarding physical examination findings, and, when necessary, correlation with pathologic findings in biopsy specimens may be used in conjunction with MR imaging to establish both the importance of these lesions and their definitive diagnoses.
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Affiliation(s)
- Sirishma Kalli
- Department of Radiology, Massachusetts General Hospital, 15 Parkman St, Wang ACC-240, Boston, MA 02114, USA
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Pace V, Wieczorek G, Pace M, Weber K, Perentes E. Spontaneous metastatic angiosarcoma of the tongue in a Wistar rat: morphological and immunohistochemical characterization. Toxicol Pathol 2010; 38:472-5. [PMID: 20215585 DOI: 10.1177/0192623310362247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A primary angiosarcoma was found in the tongue of a six-week-old female Wistar rat, sacrificed for humane reasons during the course of a four-week toxicology study. At necropsy, a nodule protruding from the dorsal part of the tongue was found. The nodule displayed microscopically, irregularly shaped vascular spaces separated by collagenous stroma. The spindle-shaped endothelial cells showed pleomorphism, hyperchromatism, and low mitotic activity; large nuclei with one or more nucleoli were present. Multiple metastases were found in the lungs, and the morphology of the cells resembled that of the primary tumor. Immunohistochemically, the primary tumor and the lung metastases were positive for von Willebrand factor and vimentin. The diagnosis of tongue angiosarcoma metastasizing to the lungs was made on the basis of microscopic and immunohistochemical findings.
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Affiliation(s)
- V Pace
- AnaPath GmbH, Oberbuchsiten 4625, Switzerland.
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Moore A, Hendon A, Hester M, Samayoa L. Secondary angiosarcoma of the breast: can imaging findings aid in the diagnosis? Breast J 2008; 14:293-8. [PMID: 18476885 DOI: 10.1111/j.1524-4741.2008.00577.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Secondary angiosarcomas, although rare, are aggressive tumors that can develop in breast tissue that has undergone prior radiation therapy. We present three cases of secondary angiosarcoma of the breast in the setting of prior breast irradiation. Imaging findings include cutaneous nodules and progressive skin or trabecular thickening in an area of the breast separate from the patient's original breast carcinoma. These imaging findings may enable the radiologist to suggest this diagnosis, even when the clinical presentation is more benign.
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Affiliation(s)
- Angela Moore
- Diagnostic Radiology, University of Kentucky, Lexington, KY, USA.
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Rozen WM, Mann GB. Angiosarcoma arising in an unirradiated breast with subsequent pituitary metastasis. Clin Breast Cancer 2007; 7:811-3. [PMID: 18021485 DOI: 10.3816/cbc.2007.n.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Angiosarcoma of the breast is a rare condition with known risk factors. The Stewart-Treves syndrome describes angiosarcoma of the arm or breast in the setting of adjuvant radiation therapy (RT) after breast conservation surgery. Angiosarcoma of the breast, in the absence of RT, is rarer still. We present a unique case of angiosarcoma of the breast, diagnosed 6 years after conservative surgery for carcinoma of the breast when no adjuvant RT was given. Chronic postoperative lymphoedema in the breast delayed the investigation of skin changes, with an eventual diagnosis of angiosarcoma. An isolated pituitary metastasis 9 months from the diagnosis, the first such reported case, adds to the complexity of the case. The diagnosis and management of angiosarcoma of the breast is discussed. Angiosarcoma is a rare occurrence after breast conservative surgery. Postoperative lymphoedema can impede early diagnosis. The disease can display unique metastatic potential.
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Affiliation(s)
- Warren M Rozen
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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