Vol 26, No 5 (2021)
Case report
Published online: 2021-08-11

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Radiation-induced breast angiosarcoma: report of two patients after accelerated partial breast irradiation (APBI) and review of the literature

Salvatore Cozzi1, Masoumeh Najafi2, Lilia Bardoscia1, Maria Paola Ruggieri1, Lucia Giaccherini1, Gladys Blandino1, Andrea Botti3, Patrizia Ciammella1, Cinzia Iotti1
Rep Pract Oncol Radiother 2021;26(5):827-831.


BACKGROUND: Angiosarcoma may rarely complicate radiotherapy of breast cancer. This so-called radiation-induced angiosarcoma (RIAS) occurs in less than 0.3% of patients that underwent breast conservation surgeries, usually years after completion of radiotherapy.

CASE PRESENTATION: we introduce two cases of invasive ductal carcinoma who underwent lumpectomy and accelerated partial breast irradiation (APBI) as an alternative protocol to whole breast irradiation (WBI). They received adjuvant partial breast radiotherapy on tumor cavity for a total dose of 38.5 Gy in 10 fractions in 5 days using 3D-external-beam RT. In both cases, RIAS occurred eight years after radiotherapy, in the sub-cicatricial area in one patient and outside the irradiated area in the other one. They both underwent radical surgery and chemotherapy was performed in one patient.

DISCUSSION: The underlying mechanism for development of RIAS is not well known, but its incidence seems to be increasing. RIAS after partial breast irradiation is very rare and has been reported in two cases so far. As it may be suggested in case 2, it is still a matter of debate if the risk of radiation-induced sarcoma is radiation-dose dependent. Although mastectomy is considered as a standard treatment, choice of treatment should be made according to the patient’s specifications.

CONCLUSION: There are very few studies in the literature that report RIAS after APBI. Present study is the only one reporting two cases after the external 3D technique APBI. Prognosis of RIAS remains poor. Only a careful evaluation in a multidisciplinary context can offer to the patients the best result in terms of local control and survival

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  1. Boyages J, Recht A, Connolly J, et al. Early breast cancer: predictors of breast recurrence for patients treated with conservative surgery and radiation therapy. Radiother Oncol. 1990; 19(1): 29–41.
  2. Kurtz J, Amalric R, Brandone H, et al. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer. 1989; 63(10): 1912–1917, doi: 10.1002/1097-0142(19890515)63:10<1912::aid-cncr2820631007>3.0.co;2-y.
  3. Coles C, Griffin C, Kirby A, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. 2017; 390(10099): 1048–1060.
  4. Viani GA, Arruda CV, Faustino AC, et al. Partial-breast irradiation versus whole-breast radiotherapy for early breast cancer: A systematic review and update meta-analysis. Brachytherapy. 2020; 19(4): 491–498.
  5. Cohen-Hallaleh RB, Smith HG, Smith RC, et al. Radiation induced angiosarcoma of the breast: outcomes from a retrospective case series. Clin Sarcoma Res. 2017; 7: 15.
  6. Lyou Y, Barber E, Mehta R, et al. Radiation-Associated Angiosarcoma of the Breast: A Case Report and Literature Review. Case Rep Oncol. 2018; 11(1): 216–220.
  7. Alves I, Marques JC. Radiation-induced angiosarcoma of the breast: a retrospective analysis of 15 years' experience at an oncology center. Radiol Bras. 2018; 51(5): 281–286.
  8. Horisawa N, Adachi Y, Sawaki M, et al. A case of radiation-associated angiosarcoma after breast cancer. Surg Case Rep. 2018; 4(1): 131.
  9. Rombouts AJM, Huising J, Hugen N, et al. Assessment of Radiotherapy-Associated Angiosarcoma After Breast Cancer Treatment in a Dutch Population-Based Study. JAMA Oncol. 2019; 5(2): 267–269.
  10. Laé M, Lebel A, Hamel‐Viard F, et al. Can c‐myc amplification reli‐ ably discriminate postradiation from primary angiosarcoma of the breast? Cancer Radiother. 2015; 19(3): 168–174.
  11. Yang W, Hennessy B, Dryden M, et al. Mammary Angiosarcomas: Imaging Findings in 24 Patients. Radiology. 2007; 242(3): 725–734.
  12. Mentzel T, Schildhaus HU, Palmedo G, et al. Postradiation cutaneous angiosarcoma after treatment of breast carcinoma is characterized by MYC amplification in contrast to atypical vascular lesions after radiotherapy and control cases: clinicopathological, immunohistochemical and molecular analysis of 66 cases. Mod Pathol. 2012; 25(1): 75–85.
  13. Shah S, Rosa M. Radiation-Associated Angiosarcoma of the Breast: Clinical and Pathologic Features. Arch Pathol Lab Med. 2016; 140(5): 477–481.
  14. Torres KE, Ravi V, Kin K, et al. Long-term outcomes in patients with radiation-associated angiosarcomas of the breast following surgery and radiotherapy for breast cancer. Ann Surg Oncol. 2013; 20(4): 1267–1274.
  15. Guo T, Zhang L, Chang NE, et al. Consistent MYC and FLT4 gene amplification in radiation-induced angiosarcoma but not in other radiation-associated atypical vascular lesions. Genes Chromosomes Cancer. 2011; 50(1): 25–33.
  16. Bonito FJ, de Almeida Cerejeira D, Dahlstedt-Ferreira C, et al. Radiation-induced angiosarcoma of the breast: A review. Breast J. 2020; 26(3): 458–463.
  17. Zalaudek I, Gomez-Moyano E, Landi C, et al. Clinical, dermoscopic and histopathological features of spontaneous scalp or face and radiotherapy-induced angiosarcoma. Australas J Dermatol. 2013; 54(3): 201–207.
  18. Selim A, Khachemoune A, Lockshin NA. Angiosarcoma: a case report and review of the literature. Cutis. 2005; 76(5): 313–317.
  19. Lehnhardt M, Bohm J, Hirsch T, et al. Radiation-induced angiosarcoma ofthe breast. Handchir Mikrochir Plast Chir. 2017; 49(2): 103–110.
  20. Glazebrook KN, Magut MJ, Reynolds C, et al. Angiosarcoma of the breast. Am J Roentgenol. 2008; 57(4): 190–192.
  21. Zemanova M, Rauova K, Boljesikova E, et al. Analysis of radiation-induced angiosarcoma of the breast. Bratisl Lek Listy. 2014; 115(5): 307–310.
  22. Hung J, Hiniker SM, Lucas DR, et al. Sporadic versus radiation-associatedangiosarcoma: a comparative clinicopathologic and molecular analysis of 48 cases. Sarcoma. 2013; 798403.
  23. Andrews S, Wilcoxon R, Benda Jo, et al. Angiosarcoma following MammoSite partial breast irradiation. Breast Cancer Res Treat. 2010; 124(1): 279–282.
  24. Mansfield SA, Zynger DL, Agnese DM. Angiosarcoma and breast cancer recurrence eight years following mammosite therapy. Breast J. 2014; 20(6): 658–660.
  25. Farran Y, Padilla O, Chambers K, et al. Atypical Presentation of Radiation-Associated Breast Angiosarcoma: A Case Report and Review of Literature. Am J Case Rep. 2017; 18: 1347–1350.
  26. Cuperus E, Leguit R, Albregts M, et al. Post radiation skin tumors: basal cell carcinomas, squamous cell carcinomas and angiosarcomas. A review of this late effect of radiotherapy. Eur J Dermatol. 2013; 23(6): 749–757.
  27. Lindford A, Böhling T, Vaalavirta L, et al. Surgical management of radiation-associated cutaneous breast angiosarcoma. J Plast Reconstr Aesthet Surg. 2011; 64(8): 1036–1042.
  28. Skubitz K, Haddad P. Paclitaxel and pegylated-liposomal doxorubicin are both active in angiosarcoma. Cancer. 2005; 104(2): 361–366.
  29. Smith TL, Morris CG, Mendenhall NP. Angiosarcoma after breast-conserving therapy: long-term disease control and late effects with hyperfractionated accelerated re-irradiation (HART). Acta Oncol. 2014; 53(2): 235–241.
  30. Billings SD, McKenney JK, Folpe AL, et al. Cutaneous angiosarcoma following breast-conserving surgery and radiation: an analysis of 27 cases. Am J Surg Pathol. 2004; 28(6): 781–788.