title: Changing clinical presentation of angiosarcomas after breast cancer: from late tumors in edematous arms to earlier tumors on the thoracic wall.
abstract: 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.
authors.affiliation: Department of Orthopedics, Lund University Hospital, 221 85 Lund, Sweden. Emelie.Styring@med.lu.se
authors.forename: Emelie
authors.initials: E
authors.lastname: Styring
authors.forename: Josefin
authors.initials: J
authors.lastname: Fernebro
authors.forename: Per-Ebbe
authors.initials: PE
authors.lastname: Jönsson
authors.forename: Anna
authors.initials: A
authors.lastname: Ehinger
authors.forename: Jacob
authors.initials: J
authors.lastname: Engellau
authors.forename: Pehr
authors.initials: P
authors.lastname: Rissler
authors.forename: Anders
authors.initials: A
authors.lastname: Rydholm
authors.forename: Mef
authors.initials: M
authors.lastname: Nilbert
authors.forename: Fredrik
authors.initials: F
authors.lastname: Vult von Steyern
mesh_terms: 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*