Breast Angiosarcoma Surveillance Study: UK national audit of management and outcomes of angiosarcoma of the breast and chest wall.,British Journal of Surgery

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Breast Angiosarcoma Surveillance Study: UK national audit of management and outcomes of angiosarcoma of the breast and chest wall.
British Journal of Surgery ( IF 9.6 ) Pub Date : 2021-04-30 , DOI: 10.1093/bjs/znaa128
J Banks ₁ , J George _{2,

3} , S Potter _{4,

5} , M D Gardiner _{6,

7} , C Ives ₁ , A M Shaaban _{8,

9} , J Singh ₁₀ , J Sherriff ₁₁ , M T Hallissey ₁₂ , K Horgan ₁₃ , A Harnett ₁₄ , A Desai ₁₂ , D J Ferguson ₁ , R Tillett ₁₅ , D Izadi ₁₅ , H Sadideen ₁₆ , A Jain _{7,

17} , C Gerrand ₁₈ , C Holcombe _{19,

20} , A Hayes ₂₁ , V Teoh ₂₁ , L Wyld ₂ ,

Affiliation

Department of Breast Surgery, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK.
Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.
Department of Plastic Surgery, Frimley Health Foundation NHS Trust, Frimley, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham, UK.
Department of Cellular Pathology, University of Birmingham, Birmingham, UK.
Department of Breast Surgery, Surrey and Sussex Healthcare NHS Trust, Redhill, UK.
Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of General Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Oncology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
Department of Plastic Surgery, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Department of Plastic and Reconstructive surgery, Imperial College Healthcare NHS Trust, London, UK.
Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.
British Association of Plastic, Reconstructive and Aesthetic Surgeons, London, UK.
Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Liverpool, UK.
Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital, London, UK.

BACKGROUND Breast angiosarcomas are rare tumours of vascular origin. Secondary angiosarcoma occurs following radiotherapy for breast cancer. Angiosarcomas have high recurrence and poor survival rates. This is concerning owing to the increasing use of adjuvant radiotherapy for the treatment of invasive breast cancer and ductal cancer in situ (DCIS), which could explain the rising incidence of angiosarcoma. Outcome data are limited and provide a poor evidence base for treatment. This paper presents a national, trainee-led, retrospective, multicentre study of a large angiosarcoma cohort. METHODS Data for patients with a diagnosis of breast/chest wall angiosarcoma between 2000 and 2015 were collected retrospectively from 15 centres. RESULTS The cohort included 183 patients with 34 primary and 149 secondary angiosarcomas. Median latency from breast cancer to secondary angiosarcoma was 6 years. Only 78.9 per cent of patients were discussed at a sarcoma multidisciplinary team meeting. Rates of recurrence were high with 14 of 28 (50 per cent ) recurrences in patients with primary and 80 of 124 (64.5 per cent ) in those with secondary angiosarcoma at 5 years. Many patients had multiple recurrences: total of 94 recurrences in 162 patients (58.0 per cent). Median survival was 5 (range 0-16) years for patients with primary and 5 (0-15) years for those with secondary angiosarcoma. Development of secondary angiosarcoma had a negative impact on predicted breast cancer survival, with a median 10-year PREDICT prognostic rate of 69.6 per cent, compared with 54.0 per cent in the observed cohort. CONCLUSION A detrimental impact of secondary angiosarcoma on breast cancer survival has been demonstrated. Although not statistically significant, almost all excess deaths were attributable to angiosarcoma. The increased use of adjuvant radiotherapy to treat low-risk breast cancer and DCIS is a cause for concern and warrants further study.

更新日期：2021-04-30

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