Neoadjuvant Reirradiation for Radiation Therapy-Associated Angiosarcoma of the Breast

Purpose Radiation-associated angiosarcoma of the breast (RAASB) is a rare side effect following breast conserving therapy (BCT) and has been associated with poor outcomes. At this time, there is no consensus regarding management of RAASB and the role of reirradiation remains controversial. We present our modern institutional outcomes in managing RAASB with incorporation of neoadjuvant hyperfractionated reirradiation. Methods Patients identified were treated between 2016 and 2020 with inclusion of any histologically proven RAASB without metastatic disease at diagnosis, while excluding those with a history of radiotherapy (RT) outside of the breast/chest wall, or other sarcoma histologies. Major wound complications were defined as requiring wound care and/or wound vac or return to the operating room for wound repair at any time following surgery. Results 8 patients were identified and median follow-up was 34 months. Median time to RAASB development was 8 years from initial RT. With respect to RAASB management, all underwent surgery and neoadjuvant reirradiation therapy (RT) and all but one received taxol-based chemotherapy. At last follow-up, 7 patients remained free of disease, and one patient died with distant disease. With respect to acute toxicity following reirradiation, all patients developed at least acute Grade 2 toxicities. Five of the eight patients developed a major wound complication. Conclusions Our institutional analysis suggests excellent local control and survival outcomes for RAASB treated with surgery, neoadjuvant hyperfractionated reirradiation, and taxol based chemotherapy. However, major wound complications represent a major challenge with this approach. Future studies should consider how best to improve the therapeutic ratio while maintaining high rates of control and survival.