title: Long-term outcomes in patients with radiation-associated angiosarcomas of the breast following surgery and radiotherapy for breast cancer.
abstract: BACKGROUND
  Radiation-associated angiosarcoma (RAAS) is a devastating disease occasionally observed in breast cancer patients treated with radiation. Due to its rarity, our knowledge-of disease risk factors, epidemiology, treatment, and outcome-is extremely limited. Therefore, we sought to identify clinicopathologic factors associated with local and distant recurrence and disease-specific survival (DSS).
  
  
  METHODS
  Radiation-associated angiosarcoma was defined as pathologically confirmed breast or chest wall angiosarcoma arising within a previously irradiated field. A comprehensive search of our institutional tumor registry (1/1/93 through 2/28/11) was used to identify patients (n = 95 females). Patient, original tumor, RAAS treatment, and outcome variables were retrospectively retrieved and assembled into a database.
  
  
  RESULTS
  The median follow-up for all RAAS patients was 10.3 (range, 2.4-31.8) years. The latency period following radiation exposure ranged from 1.4 to 26 (median, 7) years. One-year and 5-year DSS rates were 93.5 and 62.6 %, respectively. Reduced risk of local recurrence was observed in patients who received chemotherapy (P = 0.0003). In multivariable analysis, size was found to be an independent predictor of adverse outcome (P = 0.015).
  
  
  CONCLUSIONS
  Our study demonstrates that RAAS exhibits high recurrence rates. It also highlights the need for well-designed, multicenter, clinical trials to inform the true utility of chemotherapy in this disease.
authors.affiliation: Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA. ketorres@mdanderson.org
authors.forename: Keila E
authors.initials: KE
authors.lastname: Torres
authors.forename: Vinod
authors.initials: V
authors.lastname: Ravi
authors.forename: Katherine
authors.initials: K
authors.lastname: Kin
authors.forename: Min
authors.initials: M
authors.lastname: Yi
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: Caitlin D
authors.initials: CD
authors.lastname: May
authors.forename: Banu K
authors.initials: BK
authors.lastname: Arun
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Ryan
authors.initials: R
authors.lastname: Lam
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.forename: Aviad
authors.initials: A
authors.lastname: Hoffman
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Lazar
authors.forename: Dina
authors.initials: D
authors.lastname: Lev
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006394:Hemangiosarcoma / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors