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Case report
peer-reviewed

Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection



Abstract

Angiosarcoma (AS) of the breast is a rare malignancy most commonly encountered as a secondary malignancy after the treatment of breast cancer with or without adjuvant radiation. The prognosis for secondary AS is poor, with reported five-year overall survival rates ranging from 10%-43%. The establishment of local control is vital to prognosis, yet patients often die with locally progressive disease. Multiple local therapies have been employed including surgery alone, surgery followed by radiation, and concurrent radiation and hyperthermia. Here, we report a case of secondary AS that occurred after breast conserving therapy and adjuvant radiation for ductal carcinoma in situ (DCIS). After initial surgical excision and subsequent local recurrence, our patient was treated with a novel treatment intensification strategy including neoadjuvant, accelerated hyperfractionated radiation with concurrent hyperthermia, followed by total mastectomy and flap reconstruction. The final pathologic evaluation demonstrated a near-complete response to induction thermoradiotherapy.



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Case report
peer-reviewed

Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection


Author Information

Jason K. Molitoris Corresponding Author

Radiation Oncology, University of Maryland Medical Center

Arpit Chhabra

Radiation Oncology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

Nicole Harvilla

Pathology, University of Maryland Medical Center

Nkechi Okonkwo

Pathology, University of Maryland Medical Center

Elizabeth M. Nichols

Department of Radiation Oncology, University of Maryland School of Medicine

Olga B. Ioffe

Pathology, University of Maryland School of Medicine

Susan B. Kesmodel

Surgery, University of Maryland School of Medicine

Steven J. Feigenberg

Department of Radiation Oncology, University of Maryland School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. University of Maryland Medical Center Institutional Review Board issued approval HP-00063862. This research was performed on an IRB approved protocol for evaluation of safety of thermal therapy with concurrent radiation. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection


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Case report
peer-reviewed

Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection

  • Author Information
    Jason K. Molitoris Corresponding Author

    Radiation Oncology, University of Maryland Medical Center

    Arpit Chhabra

    Radiation Oncology, University of Maryland Medical Center

    James W. Snider

    Radiation Oncology, University of Maryland School of Medicine

    Nicole Harvilla

    Pathology, University of Maryland Medical Center

    Nkechi Okonkwo

    Pathology, University of Maryland Medical Center

    Elizabeth M. Nichols

    Department of Radiation Oncology, University of Maryland School of Medicine

    Zeljko Vujaskovic
    Olga B. Ioffe

    Pathology, University of Maryland School of Medicine

    Susan B. Kesmodel

    Surgery, University of Maryland School of Medicine

    Steven J. Feigenberg

    Department of Radiation Oncology, University of Maryland School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. University of Maryland Medical Center Institutional Review Board issued approval HP-00063862. This research was performed on an IRB approved protocol for evaluation of safety of thermal therapy with concurrent radiation. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: June 28, 2017

    DOI

    10.7759/cureus.1406

    Cite this article as:

    Molitoris J K, Chhabra A, Snider J W, et al. (June 28, 2017) Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection. Cureus 9(6): e1406. doi:10.7759/cureus.1406

    Publication history

    Received by Cureus: May 24, 2017
    Peer review began: May 31, 2017
    Peer review concluded: June 21, 2017
    Published: June 28, 2017

    Copyright

    © Copyright 2017
    Molitoris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Angiosarcoma (AS) of the breast is a rare malignancy most commonly encountered as a secondary malignancy after the treatment of breast cancer with or without adjuvant radiation. The prognosis for secondary AS is poor, with reported five-year overall survival rates ranging from 10%-43%. The establishment of local control is vital to prognosis, yet patients often die with locally progressive disease. Multiple local therapies have been employed including surgery alone, surgery followed by radiation, and concurrent radiation and hyperthermia. Here, we report a case of secondary AS that occurred after breast conserving therapy and adjuvant radiation for ductal carcinoma in situ (DCIS). After initial surgical excision and subsequent local recurrence, our patient was treated with a novel treatment intensification strategy including neoadjuvant, accelerated hyperfractionated radiation with concurrent hyperthermia, followed by total mastectomy and flap reconstruction. The final pathologic evaluation demonstrated a near-complete response to induction thermoradiotherapy.



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Create a free account to continue reading this article.

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Jason K. Molitoris

Radiation Oncology, University of Maryland Medical Center

For correspondence:
jmolitoris@umm.edu

Arpit Chhabra

Radiation Oncology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

Nicole Harvilla

Pathology, University of Maryland Medical Center

Nkechi Okonkwo

Pathology, University of Maryland Medical Center

Elizabeth M. Nichols

Department of Radiation Oncology, University of Maryland School of Medicine

Zeljko Vujaskovic, M.D., Ph.D.

Olga B. Ioffe

Pathology, University of Maryland School of Medicine

Susan B. Kesmodel

Surgery, University of Maryland School of Medicine

Steven J. Feigenberg

Department of Radiation Oncology, University of Maryland School of Medicine

Jason K. Molitoris

Radiation Oncology, University of Maryland Medical Center

For correspondence:
jmolitoris@umm.edu

Arpit Chhabra

Radiation Oncology, University of Maryland Medical Center

James W. Snider

Radiation Oncology, University of Maryland School of Medicine

Nicole Harvilla

Pathology, University of Maryland Medical Center

Nkechi Okonkwo

Pathology, University of Maryland Medical Center

Elizabeth M. Nichols

Department of Radiation Oncology, University of Maryland School of Medicine

Zeljko Vujaskovic, M.D., Ph.D.

Olga B. Ioffe

Pathology, University of Maryland School of Medicine

Susan B. Kesmodel

Surgery, University of Maryland School of Medicine

Steven J. Feigenberg

Department of Radiation Oncology, University of Maryland School of Medicine