title: Radiation-associated angiosarcoma after breast cancer: high recurrence rate and poor survival despite surgical treatment with R0 resection.
abstract: BACKGROUND
  Secondary angiosarcoma of the breast is a rare but severe long-term complication of breast cancer treated with breast-conserving surgery and radiotherapy. We characterized a population-based cohort of patients with secondary angiosarcomas from two tertiary hospitals to investigate this complication with respect to surgical treatment and outcome.
  
  
  METHODS
  We identified 35 patients with a history of radiation for breast cancer that developed angiosarcoma in the irradiated field from 1990 to 2009. Of these, 31 underwent surgery and were included for analysis.
  
  
  RESULTS
  Angiosarcoma developed after median 7 years (range 3-25 years). R0 resection was obtained in 23 of 31 patients after primary treatment. Local recurrence developed in 19 patients after median 6 months (range 1-89 months). Regional and distant metastases occurred in 13 patients after median 17 months (range 2-50 months); nine which also had local recurrence. Patients whose local recurrence could be operated on had a better survival after treatment than those who were not considered for surgical treatment, median 34 months (range 6-84 months) compared with 6 months (range 5-24 months). The median disease-free survival and disease-specific survival was 16 and 37 months, respectively.
  
  
  CONCLUSIONS
  Despite R0 resection, two-thirds of the patients developed a local recurrence. Survival among those with local recurrence was better if the patient could be treated with surgery. Overall, the prognosis was dismal and median DSS was just over 3 years.
authors.affiliation: Department of Surgical Oncology, University of Groningen University Medical Center, Groningen, The Netherlands.
authors.forename: Jojanneke M
authors.initials: JM
authors.lastname: Seinen
authors.forename: Emelie
authors.initials: E
authors.lastname: Styring
authors.forename: Vincent
authors.initials: V
authors.lastname: Verstappen
authors.forename: Fredrik
authors.initials: F
authors.lastname: Vult von Steyern
authors.forename: Anders
authors.initials: A
authors.lastname: Rydholm
authors.forename: Albert J H
authors.initials: AJ
authors.lastname: Suurmeijer
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006394:Hemangiosarcoma / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers