Secondary Angiosarcomas after Conservation Treatment for Breast Cancers

Česká verzia

Authors: R. Vojtíšek ¹; Z. Kinkor ²; J. Fínek ¹
Authors place of work: Radioterapeutické a onkologické oddělení, FN Plzeň ¹; Šiklův ústav patologie, LF UK v Plzni a FN Plzeň ²
Published in the journal: Klin Onkol 2011; 24(5): 382-388
Category: Kazuistiky

Summary

Backgrounds:
The cancerogenic effect of ionizing radiation was documented just several years after it started to be used as a treatment option. Ionizing radiation produces a small but detectable risk of carcinoma as well as bone and soft tissue sarcomas. Over the past 20 years angiosarcomas arising from the area of the irradiated breast have been reported with increasing frequency as the number of women undergoing the breast conserving surgery with consecutive radiotherapy has increased also. Angiosarcomas can originate from either lymphatic or capillary endothelium, namely lymphangiosarcomas and haemangiosarcomas . The most of haemangiosarcomas arising from the breast skin developed in the irradiated area after breast conserving procedure – secondary angiosarcomas. Lymphangiosarcoma is typically associated with longstanding extremity lymphedema – Stewart-Treves syndrome.

Cases:
We report three cases of angiosarcomas which occured in this region after breast conserving treatment and we also review the literature.

Conclusion:
Paradoxically, the decrease in the use of radiotherapy to the post-mastectomy chest wall and the axillary area is expected to reduce the incidence of angiosarcomas, while the increase in the use of breast conserving procedure plus radiotherapy could lead to increased incidence of angiosarcomas in the residual breast tissue. Special attention should be paid to skin leasions and changes occuring after breast conserving treatment and especially to the ones with the skinthickening. The early detection and diagnosis has the crucial prognostic value.

Key words:
secondary angiosarcoma – radiotherapy – breast cancer – breast conserving treatment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
23. 5. 2011

Accepted:
19. 9. 2011

Zdroje

1. Porter CA, White CJ. Multiple Carcinomata following Chronic X-ray Dermatitis. Ann Surg 1907; 46(5): 649–671.

2. Fry SA. Studies of U.S. radium dial workers: an epidemiological classic. Radiat Res 1998; 150 (Suppl 5): S21–S29.

3. Warren S, Sommer GN. Fibrosarcoma of the soft parts with special reference to recurrence and metastasis. Arch Surg 1936; 33: 425–450.

4. Hatcher CH. Development of sarcoma in bone subjected to roentgen or radium irradiation. J Bone Joint Surg 1945; 27: 179–195.

5. Turner WH, Greenall MJ. Sarcoma induced by radiotherapy after breast conservation surgery. Br J Surg 1991; 78(11): 1317–1318.

6. Fitzpatrick PJ. Lymphangiosarcoma and breast cancer. Can J Surg 1969; 12(2): 172–177.

7. Pierce SM, Recht A, Lingos TI et al. Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer. Int J Radiat Oncol Biol Phys 1992; 23(5): 915–923.

8. Karlsson P, Holmberg E, Johansson KA et al. Soft tissue sarcoma after treatment for breast cancer. Radiother Oncol 1996; 38(1): 25–31.

9. Fineberg S, Rosen PP. Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol 1994; 102(6): 757–763.

10. Hodgson NC, Bowen-Wells C, Moffat F et al. Angiosarcomas of the breast: a review of 70 cases. Am J Clin Oncol 2007; 30(6): 570–573.

11. Polgár C, Orosz Z, Szerdahelyi A et al. Postirradiation angiosarcoma of the chest wall and breast: issues of radiogenic origin, diagnosis and treatment in two cases. Oncology 2001; 60(1): 31–34.

12. Monroe AT, Feigenberg SJ, Mendenhall NP. Angiosarcoma after breast-conserving therapy. Cancer 2003; 97(8): 1832–1840.

13. Cozen W, Bernstein L, Wang F et al. The risk of angiosarcoma following primary breast cancer. Br J Cancer 1999; 81(3): 532–536.

14. Brennan MF, Winter S, Maki RG. Sarcomas of the Soft Tissues and Bone. In: DeVita, Hellman and Rosenberg’s Cancer: Principles and Praktice of Oncology. 8th ed. Philadelphia: Lippincott Williams&Wilkins 2008: 1741–1793.

15. Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1948; 1(1): 64–81.

16. Virtanen A, Pukkala E, Auvinen A. Angiosarcoma after radiotherapy: a cohort study of 332,163 Finnish cancer patients. Br J Cancer 2007; 97(1): 115–117.

17. Huang J, Mackillop WJ. Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma. Cancer 2001; 92(1): 172–180.

18. Kim MK, Huh SJ, Kim DY et al. Secondary angiosarcoma following irradiation-case report and review of the literature. Radiat Med 1998; 16(1): 55–60.

19. Del Mastro L, Garrone O, Guenzi M et al. Angiosarcoma of the residual breast after conservative surgery and radiotherapy for primary carcinoma. Ann Oncol 1994; 5(2): 163–165.

20. Marchal C, Weber B, de Lafontan B et al. Nine breast angiosarcomas after conservative treatment for breast carcinoma: a survey from French comprehensive Cancer Centers. Int J Radiat Oncol Biol Phys 1999; 44(1): 113–119.

21. Cahan WG, Woodward HQ, Highinbotham NL et al. Sarcoma arising in irradiated bone: report of eleven cases. Cancer 1948; 1(1): 3–29.

22. Joshi MG, Crosson AW, Tahan SR. Paget’s disease of the nipple and angiosarcoma of the breast following excision and radiation therapy for carcinoma of the breast. Mod Pathol 1995; 8(1): 1–4.

23. Clarke D, Martinez A, Cox RS et al. Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy. Cancer 1982; 49(11): 2295–2299.

24. Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol 2002; 47(1): 124–127.

25. Zietz C, Rössle M, Haas C et al. MDM-2 oncoprotein overexpression, p53 gene mutation, and VEGF up-regulation in angiosarcomas. Am J Pathol 1998; 153(5): 1425–1433.

26. McLaughlin ER, Brown LF, Weiss SW et al. VEGF and its receptors are expressed in a pediatric angiosarcoma in a patient with Aicardi’s syndrome. J Invest Dermatol 2000; 114(6): 1209–1210.

27. Fodor J, Orosz Z, Szabó E et al. Angiosarcoma after conservation treatment for breast carcinoma: our experience and a review of the literature. J Am Acad Dermatol 2006; 54(3): 499–504.

28. Weber B, Marchal C. Three cases of breast angiosarcomas after breast-conserving treatment for carcinoma. Radiother Oncol 1995; 37(3): 250–252.

29. Autio P, Kariniemi AL. Angiosarcoma. A rare secondary malignancy after breast cancer treatment. Eur J Dermatol 1999; 9(2): 118–121.

30. Liberman L, Dershaw DD, Kaufman RJ et al. Angiosarcoma of the breast. Radiology 1992; 183(3): 649–654.

31. Feigenberg SJ, Mendenhall NP, Reith JD et al. Angiosarcoma after breast-conserving therapy: experience with hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys 2002; 52(3): 620–626.

32. Fata F, O’Reilly E, Ilson D et al. Paclitaxel in the treatment of patients with angiosarcoma of the scalp or face. Cancer 1999; 86(10): 2034–2037.

33. Ray ME, McGinn CJ. Soft Tissue Sarcomas (Excluding Retroperitoneum). In: Perez and Brady’s Principles and Practice of Radiation Oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2008: 1808–1821.

34. Patton KT, Deyrup AT, Weiss SW. Atypical vascular lesions after surgery and radiation of the breast: a clinicopathologic study of 32 cases analyzing histologic heterogeneity and association with angiosarcoma. Am J Surg Pathol 2008; 32(6): 943–950.