Nine breast angiosarcomas after conservative treatment for breast carcinoma: A survey from French Comprehensive Cancer Centers

Objectives: To conduct a survey of the angiosarcomas developing after breas t conservation for carcinoma in the French Cancer Centers, to study the evo lution of these cases in detail, and to review literature in an attempt to propose an optimal treatment scheme. Material and Methods: Eleven of the 20 French Cancer Centers agreed to rese arch and retrospectively analyze all angiosarcomas discovered in patients p reviously treated by conservative treatment. The majority of the patients w ere node negative, T1N0M0. The mean age of the patients at the time of prim ary breast cancer treatment was 62.5 years, and 69 years at the diagnosis o f the angiosarcoma. Results: During the last two decades, nearly 20,000 patients have been trea ted conservatively in these 11 centers, and only 9 cases of angiosarcoma we re found. The median latency period between the treatment of the breast car cinoma and the diagnosis of the breast angiosarcoma was approximately 74 mo nths, with a range of 57-108 months. Mastectomy was performed as the main t reatment of this angiosarcoma. All recurrences after mastectomy for the ang iosarcoma appeared within 16 months after the mastectomy. A median time of recurrence was found to be 7.5 months, regardless of the treatment. The ang iosarcomas appeared to be very aggressive, and chemotherapy, radiotherapy, and sometimes hyperthermia could only palliate the condition for a short ti me. After the diagnosis of angiosarcoma, the median survival was 15.5 month s, showing a particularly poor prognosis. Only 1 patient of 9 is alive with out progressive disease at 32 months after salvage mastectomy for the recur rence of the angiosarcoma. Precise data obtained from 11 centers show that, of 18115 breast carcinomas treated conservatively, only 9 breast angiosarc omas are reported, which represents a prevalence of 5 cases of angiosarcoma per 10,000, which is the same prevalence for primary breast angiosarcomas occurring in healthy breasts. Conclusion: Angiosarcoma developing after breast conserving therapy for car cinoma is a rare event, and induction of it by treatment is controversial. However, early diagnosis is essential and it appears that radical mastectom y gives the highest chance of cure and the best long-term survival. (C) 199 9 Elsevier Science Inc.