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Angiosarcoma of the breast following surgery and radiotherapy for breast cancer

Abstract

Breast angiosarcoma following surgery and radiotherapy for breast cancer is a rare but important clinical entity. This article reviews all published cases and includes data on incidence, etiology, presentation, diagnosis, management and prognosis. Breast angiosarcoma remains challenging clinically, radiologically and histologically, and thus a high index of suspicion is required in susceptible patients. Surgery is the primary treatment option and there are an increasing number of studies on the use of radiotherapy and chemotherapy, each with variable success. There have been recent reports of patients with metastatic disease responding to taxane chemotherapy, and there might be a future role for targeted agents given the expression of c-KIT in a subset of angiosarcomas. Overall survival, however, remains poor.

Key Points

  • Angiosarcoma following breast conserving therapy is an important treatment-related complication of breast carcinoma

  • Radiotherapy, and lymphedema secondary to surgery, are involved in the etiology of the disease; the exact interplay between these two factors is unclear

  • Genetic mutations that confer sensitivity to ionizing radiation might also be involved in the pathogenesis of angiosarcoma following treatment for breast cancer

  • The diagnosis of breast angiosarcoma is challenging because of the varied clinical and radiological appearance of this malignancy, as well the histological overlap with benign vascular lesions

  • The current mainstay of treatment is surgery; radiotherapy and chemotherapy have also been used but the literature supporting these approaches is limited to case reports

  • The roles of anti-antiangiogenesis agents and tyrosine kinase inhibitors that target c-KIT are worthy of investigation given the possible importance of the VEGF signaling pathway and the expression of CD117 in these tumors

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Acknowledgements

The authors would like to thank Dr M Lesna, Consultant Histopathologist, The Royal Bournemouth Hospital, for reviewing the pathology section of the manuscript.

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Correspondence to Carlo Palmieri.

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Abbott, R., Palmieri, C. Angiosarcoma of the breast following surgery and radiotherapy for breast cancer. Nat Rev Clin Oncol 5, 727–736 (2008). https://doi.org/10.1038/ncponc1242

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