Neoadjuvant chemotherapy for radiation associated angiosarcoma (RAAS) of the breast: A retrospective single center study

• Published in: Breast (Edinburgh) Vol. 78; p. 103825
• Main Authors: van der Burg, Stijn J.C., Reijers, Sophie J.M., Kuijpers, Anke, Heimans, Lotte, Scholten, Astrid N., Haas, Rick L.M., Boven, Hester van, Kolff, Willemijn M., Vrancken Peeters, Marie-Jeanne T.F.D., Kerst, Martijn, Seinstra, Beatrijs A., Steeghs, Neeltje, van der Graaf, Winette T.A., Schrage, Yvonne M., van Houdt, Winan J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-12-2024; Elsevier
• Subjects: Original
• ISSN: 0960-9776; 1532-3080; 1532-3080
• DOI: 10.1016/j.breast.2024.103825

Radiation associated angiosarcoma (RAAS) of the breast is a rare malignancy with poor survival. Optimal treatment strategies remain uncertain due to a lack of data, and vary between surgery alone and a combination of surgery with (neo)adjuvant chemotherapy (NACT) and/or re-irradiation. The aim of this study was to evaluate the potential benefit of taxane based NACT.
In this retrospective single center study, all patients with RAAS of the breast treated between 1994 and 2024 are included. Since 2018, NACT is considered a treatment option for this patient population in our institute. The difference in oncological outcomes of patients with and without NACT were compared.
Thirty-five women were included. Thirteen (37 %) received NACT of which five (39 %) also had neoadjuvant re-irradiation with hyperthermia. Eleven patients (85 %) received paclitaxel, the other two (15 %) had doxorubicine/docetaxel. Complete pathological response was found in 69 % (n = 9). Median follow up was 41 months (range 24–56) for patients with NACT and 44 (range 20–108) for patients without NACT. In the NACT group, only one patient developed a recurrence after 6.5 years. Patients with NACT had improved oncological outcomes compared to patients without NACT in terms of 3-year local recurrence free survival (100% vs. 63.9 %, p = 0.14), distant metastasis free survival (100 % vs. 47.5 %, p = 0.005), and overall survival (100% vs. 56.1 %, p = 0.016).
In this study, neoadjuvant taxanes for RAAS of the breast leads to improved distant metastasis free survival and overal survival in patients treated with NACT compared to no NACT
•Local recurrence free survival was better in patient with NACT than without.•Distant metastasis free survival was better in patient with NACT than without.•Overall survival was better in patient with NACT than without.•Majority (69.2 %) had complete pathological response after neoadjuvant chemotherapy.