Angiosarcoma after breast-conserving therapy: experience with hyperfractionated radiotherapy.
OBJECTIVE
To report our promising results of hyperfractionated radiotherapy (RT) in conjunction with surgery for angiosarcoma occurring after breast-conserving therapy for early-stage breast cancer.


METHODS
Since 1997, 3 cases of angiosarcoma after breast-conserving therapy have been managed at the University of Florida. The histologic specimens in each case were reviewed and graded by one of us (J.D.R.).


RESULTS
Explosive growth of discolored skin lesions coincident with histologic evidence of angiosarcoma characterized all 3 cases but was preceded by a fairly indolent period (almost 2 years) of atypical vascular hyperplasia in 2 patients. All 3 patients were treated initially with radical surgery for the angiosarcoma, but extensive recurrences were noted within 1 to 2 months of surgery. Because of the extremely rapid growth noted before and after surgery, hyperfractionated RT was used. Two of the patients underwent planned resection after RT, and neither specimen demonstrated any evidence of high-grade angiosarcoma. All 3 patients were alive without any recurrent disease 22, 38, and 39 months after treatment.


CONCLUSIONS
Hyperfractionated irradiation appears to be effective treatment for rapidly proliferating angiosarcoma. For previously untreated angiosarcoma, we now recommend hyperfractionated RT followed by surgery to enhance disease control and remove as much reirradiated tissue as possible.
Feigenberg
Steven J
SJ
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
Mendenhall
Nancy Price
NP
Reith
John D
JD
Ward
Jon R
JR
Copeland
Edward M
EM
D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002278:Carcinoma in Situ / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006394:Hemangiosarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D015412:Mastectomy, Segmental; D015413:Mastectomy, Simple; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage