Clinical Outcomes for Primary and Radiation-Associated Angiosarcoma of the Breast with Multimodal Treatment: Long-Term Survival Is Achievable

Abstract

Background: The optimal management of primary angiosarcoma (PAS) and radiation-associated angiosarcoma (RAAS) of the breast remains undefined. Available data show persistently poor survival outcomes following treatment with surgery or chemotherapy alone. The objective of this study was to evaluate long-term outcomes in patients treated with multimodality therapy. Methods: Patients diagnosed with stage I–III PAS or RAAS of the breast were identified from our local tumor registry (2010–2020). Patient demographics, tumor characteristics, and treatment were collected. Primary outcomes were local recurrence (LR), distant recurrence (DR), and median overall survival (OS). A secondary outcome was pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC). Mann–Whitney U, chi-squared, or Fisher exact tests were used to analyze data. Kaplan–Meier curves compared OS for PAS and RAAS. Results: Twenty-two patients met inclusion criteria, including 11 (50%) with RAAS and 11 (50%) with PAS. Compared to PAS patients, RAAS patients were older and had more comorbidities. For RAAS patients, median time from radiation to diagnosis was 6 years (IQR: 5–11). RAAS patients were more likely to have a pCR to NAC (40% vs. 20%, p = 0.72). RAAS patients had a higher LR rate (43% vs. 38%, p = 0.83), and PAS patients were more likely to develop a DR (38% vs. 0%, p = 0.07). Median OS was 81 months in PAS patients and 90 months in RAAS patients (p = 1.00). Discussion: Long-term survival can be achieved in patients with PAS and RAAS who undergo multimodality treatment. NAC can result in pCR. The long-term clinical implications of pCR warrant further investigation.

Comment on Kronenfeld et al. Clinical Outcomes for Primary and Radiation-Associated Angiosarcoma of the Breast with Multimodal Treatment: Long-Term Survival Is Achievable. Cancers 2021, 13, 3814

“…Coincidentally, our results [5] were published 4 days later after the study carried outby Kronenfeld et al [1]. Both analyses obviously represented different RAASB situations in completely different tumor stages.…”

“…On 2 July 2021, Kronenfeld et al [1] published an excellent analysis of the clinical outcomes of primary angiosarcomas of the breast (PAS) and radiation-associated angiosarcomas of the breast (RAASB) treated with multimodality therapy in the last decade (2010-2020). They concluded, that a multimodal treatment approach that included neoadjuvant chemotherapy (NAC), radiation therapy (RT) in selected patients, surgery (S), and adjuvant chemotherapy (AC) may result in improved outcomes, including prolonged survival.…”

“…In addition, this treatment could be an option for elderly patients with reduced physical condition, as they may not be able to tolerate extended radical surgery or aggressive systemic therapy. However, due to total number of cases in both publications [1,5] further research is needed.…”

Primary angiosarcoma of the breast: a case report

“…Given poor overall outcomes and high risk of metastasis in patients with primary angiosarcoma of the breast, multimodal therapy with surgery, systemic chemotherapy, and radiation therapy has been suggested in recent literature. Chemotherapy may reduce the rate of local recurrence and increase rates of complete pathologic response (6,19). A systematic review of literature on angiosarcoma showed a beneficial role of neoadjuvant chemotherapy on downsizing tumors resulting in improved resection margins but showed no clear survival benefit (20).…”

“…Given the high incidence of local recurrence, adjuvant radiation therapy may be considered as a possible therapeutic option. Kronenfeld et al published an analysis of clinical outcomes of primary angiosarcomas and radiation-associated angiosarcomas of the breast treated with neoadjuvant chemotherapy, radiation in select patients, surgery, and adjuvant chemotherapy (19). They concluded that this multimodal treatment approach may lead to improved outcomes including prolonged survival (19).…”