Changing clinical presentation of angiosarcomas after breast cancer: from late tumors in edematous arms to earlier tumors on the thoracic wall.
Angiosarcoma is a rare complication of breast cancer treatment. In order to define predictors, clinical presentation, and outcome, we characterized a population-based 50-year cohort of angiosarcomas after breast cancer. Clinical data were collected from all females with previous breast cancer who developed angiosarcomas/lymphangiosarcomas on the thoracic wall/upper extremity between 1958 and 2008 in the Southern Swedish health care region. In total, 31 angiosarcomas developed at a median age of 71 years. The patients formed two distinct groups; 14 females treated for breast cancer with radical mastectomy and radiotherapy 1949-1988 developed angiosarcomas in edematous arms (Stewart-Treves syndrome) after median 11 years, and 17 females treated by segmental resection, anti-hormonal treatment and radiotherapy 1980-2005 developed angiosarcomas in the irradiated field on the thoracic wall after median 7.3 years. The clinical presentations were heterogeneous and included hematoma-like lesions, multiple bluish-reddish nodules, and asymptomatic lumps. The overall 5-year survival was 16%. In this population-based cohort, the early angiosarcomas developed in edematous arms after radical mastectomies, whereas more recent cases occurred after a shorter time period in the irradiated fields following breast conserving surgery. We conclude that the clinical presentation of angiosarcomas has changed, parallel with altered treatment principles for breast cancer.
Styring
Emelie
E
Department of Orthopedics, Lund University Hospital, 221 85 Lund, Sweden. Emelie.Styring@med.lu.se
Fernebro
Josefin
J
Jönsson
Per-Ebbe
PE
Ehinger
Anna
A
Engellau
Jacob
J
Rissler
Pehr
P
Rydholm
Anders
A
Nilbert
Mef
M
Vult von Steyern
Fredrik
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D004487:Edema / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D006394:Hemangiosarcoma / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D035441:Thoracic Wall / Q000473:pathology*