Breast (Dec 2024)

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

  • Stijn J.C. van der Burg,
  • Sophie J.M. Reijers,
  • Anke Kuijpers,
  • Lotte Heimans,
  • Astrid N. Scholten,
  • Rick L.M. Haas,
  • Hester van Boven,
  • Willemijn M. Kolff,
  • Marie-Jeanne T.F.D. Vrancken Peeters,
  • Martijn Kerst,
  • Beatrijs A. Seinstra,
  • Neeltje Steeghs,
  • Winette T.A. van der Graaf,
  • Yvonne M. Schrage,
  • Winan J. van Houdt

Journal volume & issue
Vol. 78
p. 103825

Abstract

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Background: 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. Methods: 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. Results: 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). Conclusion: 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