Radiotherapy-associated angiosarcoma in the breast reconstructed by autologous free-flap and treated with electrochemotherapy

Abstract

BackgroundRadiotherapy-associated angiosarcoma (RAA) of the breast is a rare complication of radiotherapy, which is often difficult to identify and has poor prognosis. It usually presents as violaceous skin, erythema or rapidly growing palpable firm mass that can be confused with other benign skin lesions.Patients and methodsAfter reviewing the literature, we found only four cases with RAA after mastectomy and autologous breast reconstruction. The presented case is the first that was treated by electrochemotherapy. The patient presented with secondary angiosarcoma of the breast five years after mastectomy, immediate breast reconstruction with deep inferior epigastric artery perforator free flap and adjuvant radiotherapy.ResultsElectrochemotherapy was feasible, safe and effective in treatment of radiation induced sarcoma. Most of the treated lesions in several consecutive electrochemotherapy sessions responded with complete response, but multiple recurrences occurred in non-treated areas.ConclusionsPatients with breast cancer after skin-sparing mastectomy and immediate breast reconstruction, who receive radiotherapy, need regular long-term follow up and low threshold for biopsy of any suspicious lesions is mandatory. Electrochemotherapy proved as one of feasible modalities of treatment for RAA.

Post-Irradiation Breast Angiosarcoma: All the Possible Treatments and Electrochemotherapy. Case Report and Literature Review

“…The technique was feasible, safe and effective in treatment of the disease. Most of the treated lesions reached a complete response in several consecutive ECT sessions, but multiple recurrences occurred in nontreated areas [14]. ECT may represent one of the feasible options in the management of RAS.…”

“…In a systematic review literature search of the database PubMed (search date 10 February 2023) using the search terms "angiosarcoma and electrochemotherapy", we identified only 14 citations [9,12,[14][15][16][17][18][19][20][21][22][23][24][25]. Seven studies were excluded because two of them were commentary [15,16], one referred to the animal population [9], another was about melanoma or non-melanoma diseases [20], two were about the Stewart-Treves Syndrome [18][19][20][21], and one was not about RAS [22].…”

“…Only six studies reported the histology of the previous breast cancer, and luminal subtypes are prevalent (6/6 cases reported). All the patients received a conservative surgical approach (quadrantectomy), except a patient who underwent mastectomy [14]. Only two women received adjuvant CT. All the patients (6/6) were treated with hormonal therapy and adjuvant RT.…”

An Unexpected Late Recurrence of Breast Irradiation-Induced Angiosarcoma Following Autologous Microvascular Breast Reconstruction

“…Reports have demonstrated a potential role for electrochemotherapy in managing cutaneous recurrences in which radiotherapy is contraindicated. However, a short disease-free interval was observed with further recurrences detected within two months, suggesting the need for a multimodal approach [ 16 ].…”

Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation

“…According to a couple of multicentre studies with 19 and 20 patients, the ORR was 63–80% and CRR 40–42% [ 168 , 169 ]. However, despite these encouraging results, soft tissue angiosarcomas exhibit distinct and challenging presentations, particularly in breast cancer patients, and require an aggressive, coordinated multidisciplinary approach [ 170 , 171 ].…”