Abstract
Background
Breast angiosarcomas (AS) are rare tumours of vascular origin. Secondary AS (SAS) occurs following radiotherapy (RT) for breast cancer (BC). AS have high recurrence rates and poor survival. This is concerning due to increasing use of adjuvant radiotherapy for the treatment of BC and in situ disease which may explain the rising incidence of AS. Outcome data is limited, providing poor evidence base for treatment. This paper presents a national, trainee-led, retrospective multicentre study describing the largest AS cohort published to date.
Methods:
Data from patients with a diagnosis of breast/chest wall AS between 2000-2015 were retrospectively collected from 15 centres.
Results:
The cohort included 183 patients: 34 primary AS (PAS) and 149 SAS. Median latency from BC to SAS: 6 years. Only 78.9% of patients were discussed at a sarcoma multidisciplinary team meeting. Rates of recurrence were high with 6/31 PAS (19.4%) and 60/134 SAS (44.8%) at 5 years, with many patients having multiple recurrences (total recurrences 90/165, 54.5%). Median survival was 4 (0-16) years for PAS, 3 (0-15) years for SAS. Development of SAS had a negative impact on breast cancer predicted survival (median 10-year PREDICT prognostic score for BC; 68.95%, versus observed predict cohort survival; 55.3%).
Conclusion:
This is the first study to estimate the detrimental impact of SAS on BC survival. Though non-statistically significant, almost all excess deaths are attributable to AS. The increased use of adjuvant RT to treat low risk breast cancer and DCIS is a cause for concern and warrants further study.
Breast angiosarcomas (AS) are rare tumours of vascular origin. Secondary AS (SAS) occurs following radiotherapy (RT) for breast cancer (BC). AS have high recurrence rates and poor survival. This is concerning due to increasing use of adjuvant radiotherapy for the treatment of BC and in situ disease which may explain the rising incidence of AS. Outcome data is limited, providing poor evidence base for treatment. This paper presents a national, trainee-led, retrospective multicentre study describing the largest AS cohort published to date.
Methods:
Data from patients with a diagnosis of breast/chest wall AS between 2000-2015 were retrospectively collected from 15 centres.
Results:
The cohort included 183 patients: 34 primary AS (PAS) and 149 SAS. Median latency from BC to SAS: 6 years. Only 78.9% of patients were discussed at a sarcoma multidisciplinary team meeting. Rates of recurrence were high with 6/31 PAS (19.4%) and 60/134 SAS (44.8%) at 5 years, with many patients having multiple recurrences (total recurrences 90/165, 54.5%). Median survival was 4 (0-16) years for PAS, 3 (0-15) years for SAS. Development of SAS had a negative impact on breast cancer predicted survival (median 10-year PREDICT prognostic score for BC; 68.95%, versus observed predict cohort survival; 55.3%).
Conclusion:
This is the first study to estimate the detrimental impact of SAS on BC survival. Though non-statistically significant, almost all excess deaths are attributable to AS. The increased use of adjuvant RT to treat low risk breast cancer and DCIS is a cause for concern and warrants further study.
| Original language | English |
|---|---|
| Article number | znaa128 |
| Pages (from-to) | 388-394 |
| Number of pages | 7 |
| Journal | British Journal of Surgery |
| Volume | 108 |
| Issue number | 4 |
| Early online date | 22 Mar 2021 |
| DOIs | |
| Publication status | Published - 30 Apr 2021 |
Bibliographical note
Publisher Copyright:© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: [email protected].
Keywords
- hemangiosarcoma
- radiation therapy
- cancer
- ductal carcinoma in situ
- multicenter studies
- patient care team
- radiotherapy
- adjuvant
- sarcoma
- survival rate
- breast
- diagnosis
- neoplasms
- patient prognosis
- breast cancer
- chest wall
- surveillance
- medical
- invasive breast cancer
- evidence-based practice
- breast hemangiosarcoma
- excess mortality
Access to Document
- Full-text PDF (author’s accepted manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via British Journal of Surgery Society at https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znaa128/6179787 . Please refer to any applicable terms of use of the publisher.