title: Angiosarcoma after breast-conserving therapy.
abstract: BACKGROUND
  Angiosarcoma arising in the irradiated breast after breast-conserving therapy is being reported with increasing frequency. As more women undergo breast-conserving therapy, the incidence can be expected to increase. Surgeons, medical oncologists, and radiation oncologists will be faced with difficult management decisions for this aggressive disease.
  
  
  METHODS
  A comprehensive review of all English-language reports of angiosarcomas after breast-conserving therapy was performed. Approximately 100 cases were reviewed for treatment details and outcome analysis was performed.
  
  
  RESULTS
  Surgical excision is associated with very high rates of disease recurrence (55 of 75 patients with at least 1 year of follow-up; 73%). Local disease recurrences in the tumor bed or along the mastectomy scar are a component of almost all recurrences (96%). Distant metastases develop simultaneously or shortly after local recurrences. Hyperfractionated radiotherapy has successfully prevented local disease recurrences in a limited number of patients.
  
  
  CONCLUSIONS
  Angiosarcoma after breast-conserving therapy is increasingly diagnosed in a small but significant portion of breast carcinoma survivors. The aggressive nature of this disease demands further investigation of adjuvant therapy to prevent recurrence of disease after surgery.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Monroe
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Feigenberg
authors.forename: Nancy Price
authors.initials: NP
authors.lastname: Mendenhall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000209:etiology* / Q000628:therapy*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006394:Hemangiosarcoma / Q000209:etiology*; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology*; D017741:Survivors