Outcomes following extended resection of radiation-induced angiosarcoma of the breast: a sarcoma unit experience and systematic review

PurposeRadiation-induced angiosarcoma (RIAS) of the breast is a rare tumour with high rate of local recurrence. The aim of this study is to evaluate the outcome of radical resections.MethodsA retrospective analysis of all patients who underwent extended surgical resection for RIAS of the breast between 2013 and 2022. Included were patients who underwent radical resection, including complete resection of previously irradiated skin and underlying fascia of pectoralis major. Post-operative and long-term oncological outcomes were than analysed. A systematic review was performed using the MEDLINE database in the last 20 years.ResultsTwenty-two (n = 22) patients met the inclusion criteria. The median length of the specimen was 220 mm (range, 120-377 mm). At a median follow-up of 33.5 months (range, 7.9-102.4), 3 (13.6%) patients had both local and metastatic lung disease and 1 (4%) patient with only lung metastasis. The estimated 3- and 5-year OS was 81.1% and 57.9%, respectively. The estimated 3- and 5-year DSS was 91.7% and 65.5%, respectively. The estimated 3- and 5-year DFS rate were both 75.2%. The systematic review identified 17 studies with a recurrence rate ranging from 33% to 100%.ConclusionsTreatment of RIAS of the breast with an up-front locally extended approach is associated with a low rate of local recurrence compared with the reported literature. Radiation-induced angiosarcoma of the breast is a rare and aggressive form of sarcoma. Extended resection of the majority of irradiated skin and breast tissue provides good oncological outcomes with an acceptable post-operative complication rate.image