Is there a role for adjuvant therapy in radiation-induced angiosarcoma of the breast? A case report and review of the literature

BACKGROUND: Angiosarcoma (AS) of the breast is very rare, accounting for 1% of all soft tissue breast tumors. AS may present as primary tumors of the breast or as secondary lesions usually associated with previous radio-therapy. Commonly, secondary AS affects old-er women (median age 67-71 years) with a clin-ical history of breast cancer. The preferred site of onset of RIAS is the edge of radiation fields, where radiation doses and tumor necrosis may be heterogeneous, resulting in a DNA damage and instability. Radical surgery is the treatment of choice, but no clear consensus exists on sur-gical management of breast AS.CASE REPORT: We describe an atypical case of relapsed RIAS after radical mastectomy, treat-ed with new surgery and, considering the higher risk of recurrence, subsequent adjuvant chemo-therapy with weekly paclitaxel.CONCLUSIONS: The frequency of radiation -in-duced angiosarcomas (RIAS) after breast -con-serving surgery and radiotherapy has been in-creased to 0.14-0.5% among long survivors. Nev-ertheless, even if RIAS continues to be prognos-tically an extremely unfavorable cancer due to a high rate of recurrence, distant spread, and me-dian overall survival (OS) of about 60 months, the benefits of loco-regional breast radiotherapy are clearly higher than the risk in developing angio-sarcoma.