Clinical management of secondary angiosarcoma after breast conservation therapy
Identifieur interne : 003184 ( Pmc/Curation ); précédent : 003183; suivant : 003185Clinical management of secondary angiosarcoma after breast conservation therapy
Auteurs : Martina Zemanova [Slovaquie] ; Katarina Machalekova [Slovaquie] ; Monika Sandorova [Slovaquie] ; Elena Boljesikova [Slovaquie] ; Marta Skultetyova [Slovaquie] ; Juraj Svec [Slovaquie] ; Andrej Zeman [Autriche]Source :
- Reports of Practical Oncology and Radiotherapy [ 1507-1367 ] ; 2013.
Abstract
The aim of this paper is to summarize the treatment outputs of secondary angiosarcoma after breast conservation therapy at St. Eizabeth Cancer Centre, Slovakia.
Angiosarcoma of the breast is a rare but very aggressive malignant tumor of the vascular endothelium, characterized by rapidly proliferating and extensively infiltrating growth. Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. Radiotherapy in the treatment of breast cancer is associated with an increased risk of subsequent sarcoma.
Retrospective study of medical records from the cancer databases was done in order to analyze the secondary breast angiosarcoma. This disease is an iatrogenic condition that warrants close follow-up and judicial use of radiotherapy in breast conserving therapy. Therefore, it is more prevalent in cases treated with radiotherapy, occurring especially in or adjacent to the radiation field. Clinical histories and follow-up data of identified patients after breast conservation therapy of invasive breast cancer were reviewed. In addition, a comprehensive literature review on diagnosis and treatment procedures was done in order to summarize state-of-the-art clinical approach.
Three cases of secondary angiosarcoma after breast conservation therapy (BCT) were identified among 4600 patients treated at St. Elizabeth Cancer Institute during previous 16 years (1995–2011). Secondary breast angiosarcoma was diagnosed in a median period of 11 years following primary radiotherapy, median age at the time of diagnosis was 75 years. Surgical treatment consisted of radical mastectomy. The first patient, a 56-year-old woman received neoadjuvant chemotherapy (docetaxel + gemcitabin), second one (75 year) was treated by radiotherapy (TD 26 Gy, 2 Gy per fraction), since chemotherapy was not indicated. The last patient (80 year) got adjuvant chemotherapy (paclitaxel). Average follow up of the patients was 31 months. As of 31 July 2012, our patients were doing well without evidence of recurrent disease after treatment.
Angiosarcoma remains a difficult management problem with poor loco-regional and distal control. In our study, an overall incidence rate of secondary breast angiosarcoma is 0.065%. Although the prognosis for this disease is poor (typical survival period is 14.5–34 months with a 5-year survival rate of approximately 15%), all the three patients treated at our institute are alive and disease-free at the end of reported period. Finally, it is assumed that the use of breast conserving therapy will increase the incidence of post-irradiation angiosarcoma but the small difference in risk of subsequent sarcoma of the breast cancer patients receiving radiotherapy does not suppress its benefit.
Url:
DOI: 10.1016/j.rpor.2013.07.013
PubMed: 24936318
PubMed Central: 4056516
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<author><name sortKey="Zemanova, Martina" sort="Zemanova, Martina" uniqKey="Zemanova M" first="Martina" last="Zemanova">Martina Zemanova</name>
<affiliation wicri:level="1"><nlm:aff id="aff0005">1st Department of Oncology, Faculty of Medicine, Comenius University and St. Elisabeth Cancer Institute, Bratislava, Slovakia</nlm:aff>
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<author><name sortKey="Machalekova, Katarina" sort="Machalekova, Katarina" uniqKey="Machalekova K" first="Katarina" last="Machalekova">Katarina Machalekova</name>
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<series><title level="j">Reports of Practical Oncology and Radiotherapy</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Aim</title>
<p>The aim of this paper is to summarize the treatment outputs of secondary angiosarcoma after breast conservation therapy at St. Eizabeth Cancer Centre, Slovakia.</p>
</sec>
<sec><title>Background</title>
<p>Angiosarcoma of the breast is a rare but very aggressive malignant tumor of the vascular endothelium, characterized by rapidly proliferating and extensively infiltrating growth. Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. Radiotherapy in the treatment of breast cancer is associated with an increased risk of subsequent sarcoma.</p>
</sec>
<sec><title>Materials and methods</title>
<p>Retrospective study of medical records from the cancer databases was done in order to analyze the secondary breast angiosarcoma. This disease is an iatrogenic condition that warrants close follow-up and judicial use of radiotherapy in breast conserving therapy. Therefore, it is more prevalent in cases treated with radiotherapy, occurring especially in or adjacent to the radiation field. Clinical histories and follow-up data of identified patients after breast conservation therapy of invasive breast cancer were reviewed. In addition, a comprehensive literature review on diagnosis and treatment procedures was done in order to summarize state-of-the-art clinical approach.</p>
</sec>
<sec><title>Results and discussions</title>
<p>Three cases of secondary angiosarcoma after breast conservation therapy (BCT) were identified among 4600 patients treated at St. Elizabeth Cancer Institute during previous 16 years (1995–2011). Secondary breast angiosarcoma was diagnosed in a median period of 11 years following primary radiotherapy, median age at the time of diagnosis was 75 years. Surgical treatment consisted of radical mastectomy. The first patient, a 56-year-old woman received neoadjuvant chemotherapy (docetaxel + gemcitabin), second one (75 year) was treated by radiotherapy (TD 26 Gy, 2 Gy per fraction), since chemotherapy was not indicated. The last patient (80 year) got adjuvant chemotherapy (paclitaxel). Average follow up of the patients was 31 months. As of 31 July 2012, our patients were doing well without evidence of recurrent disease after treatment.</p>
</sec>
<sec><title>Conclusions</title>
<p>Angiosarcoma remains a difficult management problem with poor loco-regional and distal control. In our study, an overall incidence rate of secondary breast angiosarcoma is 0.065%. Although the prognosis for this disease is poor (typical survival period is 14.5–34 months with a 5-year survival rate of approximately 15%), all the three patients treated at our institute are alive and disease-free at the end of reported period. Finally, it is assumed that the use of breast conserving therapy will increase the incidence of post-irradiation angiosarcoma but the small difference in risk of subsequent sarcoma of the breast cancer patients receiving radiotherapy does not suppress its benefit.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Rep Pract Oncol Radiother</journal-id>
<journal-title-group><journal-title>Reports of Practical Oncology and Radiotherapy</journal-title>
</journal-title-group>
<issn pub-type="ppub">1507-1367</issn>
<issn pub-type="epub">2083-4640</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">24936318</article-id>
<article-id pub-id-type="pmc">4056516</article-id>
<article-id pub-id-type="publisher-id">S1507-1367(13)01018-3</article-id>
<article-id pub-id-type="doi">10.1016/j.rpor.2013.07.013</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Clinical management of secondary angiosarcoma after breast conservation therapy</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Zemanova</surname>
<given-names>Martina</given-names>
</name>
<email>mata.zemanova@gmail.com</email>
<xref rid="aff0005" ref-type="aff">a</xref>
<xref rid="aff0010" ref-type="aff">b</xref>
<xref rid="cor0005" ref-type="corresp">⁎</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Machalekova</surname>
<given-names>Katarina</given-names>
</name>
<xref rid="aff0015" ref-type="aff">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sandorova</surname>
<given-names>Monika</given-names>
</name>
<xref rid="aff0010" ref-type="aff">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Boljesikova</surname>
<given-names>Elena</given-names>
</name>
<xref rid="aff0010" ref-type="aff">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Skultetyova</surname>
<given-names>Marta</given-names>
</name>
<xref rid="aff0020" ref-type="aff">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Svec</surname>
<given-names>Juraj</given-names>
</name>
<xref rid="aff0005" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zeman</surname>
<given-names>Andrej</given-names>
</name>
<xref rid="aff0025" ref-type="aff">e</xref>
</contrib>
</contrib-group>
<aff id="aff0005"><label>a</label>
1st Department of Oncology, Faculty of Medicine, Comenius University and St. Elisabeth Cancer Institute, Bratislava, Slovakia</aff>
<aff id="aff0010"><label>b</label>
Department of Radiation Oncology, St. Elizabeth Cancer Institute, Bratislava, Slovakia</aff>
<aff id="aff0015"><label>c</label>
Department of Pathology, St. Elizabeth Cancer Institute, Bratislava, Slovakia</aff>
<aff id="aff0020"><label>d</label>
Department of Clinical Oncology, St. Elizabeth Cancer Institute, Bratislava, Slovakia</aff>
<aff id="aff0025"><label>e</label>
Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria</aff>
<author-notes><corresp id="cor0005"><label>⁎</label>
Corresponding author at: Faculty of Medicine, Comenius University, Bratislava, Slovakia. Tel.: +421 245996810. <email>mata.zemanova@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>23</day>
<month>8</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="collection"><month>1</month>
<year>2014</year>
</pub-date>
<volume>19</volume>
<issue>1</issue>
<fpage>37</fpage>
<lpage>46</lpage>
<history><date date-type="received"><day>10</day>
<month>9</month>
<year>2012</year>
</date>
<date date-type="rev-recd"><day>11</day>
<month>4</month>
<year>2013</year>
</date>
<date date-type="accepted"><day>25</day>
<month>7</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>© 2014 Greater Poland Cancer Centre. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.</copyright-statement>
<copyright-year>2013</copyright-year>
<copyright-holder>Greater Poland Cancer Centre</copyright-holder>
</permissions>
<abstract><sec><title>Aim</title>
<p>The aim of this paper is to summarize the treatment outputs of secondary angiosarcoma after breast conservation therapy at St. Eizabeth Cancer Centre, Slovakia.</p>
</sec>
<sec><title>Background</title>
<p>Angiosarcoma of the breast is a rare but very aggressive malignant tumor of the vascular endothelium, characterized by rapidly proliferating and extensively infiltrating growth. Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. Radiotherapy in the treatment of breast cancer is associated with an increased risk of subsequent sarcoma.</p>
</sec>
<sec><title>Materials and methods</title>
<p>Retrospective study of medical records from the cancer databases was done in order to analyze the secondary breast angiosarcoma. This disease is an iatrogenic condition that warrants close follow-up and judicial use of radiotherapy in breast conserving therapy. Therefore, it is more prevalent in cases treated with radiotherapy, occurring especially in or adjacent to the radiation field. Clinical histories and follow-up data of identified patients after breast conservation therapy of invasive breast cancer were reviewed. In addition, a comprehensive literature review on diagnosis and treatment procedures was done in order to summarize state-of-the-art clinical approach.</p>
</sec>
<sec><title>Results and discussions</title>
<p>Three cases of secondary angiosarcoma after breast conservation therapy (BCT) were identified among 4600 patients treated at St. Elizabeth Cancer Institute during previous 16 years (1995–2011). Secondary breast angiosarcoma was diagnosed in a median period of 11 years following primary radiotherapy, median age at the time of diagnosis was 75 years. Surgical treatment consisted of radical mastectomy. The first patient, a 56-year-old woman received neoadjuvant chemotherapy (docetaxel + gemcitabin), second one (75 year) was treated by radiotherapy (TD 26 Gy, 2 Gy per fraction), since chemotherapy was not indicated. The last patient (80 year) got adjuvant chemotherapy (paclitaxel). Average follow up of the patients was 31 months. As of 31 July 2012, our patients were doing well without evidence of recurrent disease after treatment.</p>
</sec>
<sec><title>Conclusions</title>
<p>Angiosarcoma remains a difficult management problem with poor loco-regional and distal control. In our study, an overall incidence rate of secondary breast angiosarcoma is 0.065%. Although the prognosis for this disease is poor (typical survival period is 14.5–34 months with a 5-year survival rate of approximately 15%), all the three patients treated at our institute are alive and disease-free at the end of reported period. Finally, it is assumed that the use of breast conserving therapy will increase the incidence of post-irradiation angiosarcoma but the small difference in risk of subsequent sarcoma of the breast cancer patients receiving radiotherapy does not suppress its benefit.</p>
</sec>
</abstract>
<kwd-group><title>Keywords</title>
<kwd>Breast cancer</kwd>
<kwd>Sarcoma</kwd>
<kwd>External-beam radiotherapy</kwd>
<kwd>Multimodality therapy</kwd>
<kwd>Radiationinduced late effects</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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