Angiosarcoma of the Breast: A Rare Complication of Radiation Therapy. Clinicopathologic Study of 33 Cases in a Single Institution
EA Morgan, CM Mery, DE Kozono, JE Butrynski, EH Baldini, CP Raut, AF Nascimento. Brigham and Women's Hospital (BWH), Boston, MA; BWH and Dana-Farber Cancer Institute (DFCI), Boston; DFCI, Boston; BWH, Boston
Background: Angiosarcoma of the breast (BrAS) may involve mammary parenchyma or the skin of the breast. The latter is a rare but serious complication of radiotherapy (RT) following breast conservation management of breast carcinoma.
Design: We reviewed all cases of BrAS evaluated at our institution from 1987 to 2008. Only cases arising in the setting of RT for breast carcinoma were included in this study. Cases of primary mammary angiosarcoma were excluded. Tumors were graded using a three-tier system. Clinicopathologic data were obtained by medical records review. Survival was analyzed by Kaplan-Meier curve.
Results: The cohort included 33 women (mean age 66 yrs, range 34 to 87) who received RT for invasive ductal (n=27), lobular (1) or mucinous (2) breast carcinoma, or DCIS (3). Median interval between RT and BrAS was 78 mos (range 36 to 156). Lesions usually presented as violaceous nodules on the skin within the area of prior RT. Time from initial symptoms to diagnosis was a median of 2.9 mos (range 0 to 23). Morphologically, BrAS were composed of anastomosing vascular channels showing multilayering of endothelial cells and nuclear atypia. The majority of tumors (70%) were histologically high grade. All patients (pts) underwent surgery (85% mastectomy; 15% wide excision of chest wall). Eight (24%) pts received chemotherapy (7 neoadjuvant and 1 adjuvant). 42% of pts developed local recurrence and 9% developed distant metastasis (median 11 and 16 mos after RAS diagnosis, respectively). Recurrent disease was managed by surgery alone (n=4), chemotherapy (4), RT (1), surgery plus chemotherapy (4), or surgery, RT and chemotherapy (1). The median follow-up was 17.3 months. Twelve (36%) pts died. Median overall survival was 49 mos (5-year survival 39%).
Conclusions: BrAS is a rare complication of RT for conservative treatment of breast carcinoma. The latency period is approximately 80 months and the majority of angiosarcomas that develop subsequent to breast-conserving RT are morphologically high grade lesions. Local recurrences are quite common. Prognosis is similar to that seen in angiosarcomas of soft tissue and is poor with a median survival of 49 months and overall 5-year survival of 39%.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 18, Tuesday Afternoon