An Update on Radiation-Induced Angiosarcoma of the Breast: A Diagnostic and Management Challenge

Christine Zhao (1), Hema Mahajan (2), Phuong Dinh (3), Najmun Nahar (4), T Michael Hughes (5), Nicholas Ngui (6)
(1) Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Australia,
(2) Western Sydney Local Health District, Sydney, Australia, Australia,
(3) Western Sydney Local Health District, Sydney, Australia, Australia,
(4) Western Sydney Local Health District, Sydney, Australia, Australia,
(5) Sydney Adventist Hospital, Sydney, Australia, Australia,
(6) Western Sydney Local Health District, Sydney, Australia, Australia

Abstract

Background: Post-radiation angiosarcoma (AS) of the breast, also known as radiation-associated angiosarcoma (RAAS) or radiation-induced angiosarcoma (RIAS), is a rare complication after breast radiotherapy. The diagnosis and management of post-radiation AS is challenging because of its non-specific but aggressive presentation. This study aims to examine the experience of a local health district with post-radiation AS to improve awareness of this condition. 


Methods: A retrospective case series was performed on patients diagnosed with post-radiation AS within Western Sydney Local Health District between 2000-2021. Eligibility criteria included patients with histologically proven breast angiosarcoma and a history of past breast radiotherapy.


Results: 11 patients had post-radiation AS of the breast. The annual incidence was 1 in 18,000 of the breast radiotherapy treated population. Descriptive analysis was performed on six patients. The median age was 67 years, with a median latency period of 5.5 years. All patients presented with non-specific skin changes. Core/punch biopsy was inconclusive in five patients. Mastectomy was the mainstay of treatment. Three patients had disease recurrence. The five-year survival rate was 68%. 


Conclusion: Post-radiation AS of the breast is a rare disease associated with a poor prognosis due to its aggressive nature and high recurrence rate. Diagnosis is challenging with high false-negative rates associated with imaging and biopsy. It is important to maintain a high index of suspicion in patients treated with past breast radiotherapy.

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Authors

Christine Zhao
christinezhao95@gmail.com (Primary Contact)
Hema Mahajan
Phuong Dinh
Najmun Nahar
T Michael Hughes
Nicholas Ngui
Author Biographies

Hema Mahajan, Western Sydney Local Health District, Sydney, Australia

Dr Mahajan is an experienced breast Pathologist and has been involved in extensive research including 45 publications. She has helped diagnose to several breast angiosarcomas in her career. 

Phuong Dinh, Western Sydney Local Health District, Sydney, Australia

Dr Phuong is a senior Medical Oncologist in the WSLHD and has treated several patients with angiosarcomas throughout her career. 

Najmun Nahar, Western Sydney Local Health District, Sydney, Australia

Dr Nahar is a Radiation Oncologist and plays an active member of multidisciplinary meetings for cancer and has special interest in breast cancer. She has treated a few patients with breast angiosarcoma in her career.

T Michael Hughes, Sydney Adventist Hospital, Sydney, Australia

A/Prof Hughes is the founder and Clinical Director of Northern Surgical Oncology (NSO). He is a Surgical Oncologist with over 30 years’ experience,having trained as a general surgeon then pursued post-fellowship training in surgical oncology. His expertise includes the management of breast cancer as well as benign breast disease, melanoma as well as advanced and rare non-melanoma skin cancers, soft tissue tumours benign and sarcoma, salivary gland tumours and lymph node malignancy (neck, axilla and groin).   Michael is involved in research, education, leadership and quality management systems at NSO, the Sydney Adventist Hospital (SAH) and more broadly. In addition to his medical practice Michael has number of significant leadership roles including -the Head of the Sydney Adventist Hospital Clinical School, the University of Sydney; the Clinical Director of Surgical Services and a member of the Medical Advisory Committee at SAH; Chairman of the SAH Breast Cancer and Surgical Oncology/Head and Neck MDTs; Chairman of the Section of Surgical Oncology of the Royal Australasian College of Surgeons; committee member on a number of state and national advisory groups.

Nicholas Ngui, Western Sydney Local Health District, Sydney, Australia

A/Prof. Nicholas Ngui is a specialist surgeon at the Sydney Adventist Hospital with expertise in breast, thyroid, skin and general surgery conditions. He has been practicing as a surgeon for 10 years and is dedicated in providing the best possible patient care. Growing up in Sydney he started his medical degree in 1998 at the University of New South Wales graduating with honours in 2003 (BSc Med MBBS Hons). He was an intern and resident medical officer at Westmead Hospital and did his surgical training in Sydney obtaining his Fellowship with the Royal Australasian College of Surgeons (FRACS) in 2011. This was followed by further subspecialty training in surgical oncology in breast and thyroid surgery. 

 

Most of his work now involves a mixture of breast surgery (including advanced oncoplastic and reconstructive breast surgery), thyroid and parathyroid surgery, skin cancer surgery and general surgery including laparoscopic hernia and gallbladder surgery. He has a strong presence at the Sydney Adventist hospital and the Northern Surgical Oncology (NSO) San clinic where he has been working since 2013. He is a breast surgeon at the local Breastscreen Northern Sydney program. A/Prof. Nicholas Ngui is a prominent breast surgeon at the San where over the years he has made significant contributions and advancements to the breast unit and breast cancer research at the Sydney Adventist Hospital. He is heavily committed to research with numerous past and current research presented and published in international conferences and peer reviewed journals. He has a strong work ethic and duty of care for his patients. He is a dedicated teacher and supervisor of medical students and junior doctors both in the hospital setting and with the College of Surgeons. At the San he is actively involved with quality improvement through research and chairing the surgery department audit. His practice is current and evidence based. 

 

1.
Zhao C, Mahajan H, Dinh P, Nahar N, Hughes TM, Ngui N. An Update on Radiation-Induced Angiosarcoma of the Breast: A Diagnostic and Management Challenge. Arch Breast Cancer [Internet]. 2023 Sep. 4 [cited 2024 May 23];10(4):340-6. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/758

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