Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
Cancer. 2010 Apr 15;116(8):1872-8. doi: 10.1002/cncr.24995.
With breast-conserving therapy (BCT) as the standard of care for patients with noninvasive and early stage invasive breast cancer, a small incidence of post-BCT angiosarcoma has emerged. The majority of therapeutic interventions have been unsuccessful. To the authors' knowledge, there is no consensus in the medical literature to date regarding the treatment of this malignancy. The current study was conducted to report the long-term outcomes of a novel approach using hyperfractionated and accelerated radiotherapy (HART) for angiosarcoma developing after BCT.
The authors retrospectively reviewed the outcomes of 14 patients treated with HART with or without surgery at the University of Florida between November 1997 and March 2006 for angiosarcoma that developed after BCT.
At the time of last follow-up, 9 patients had remained continuously without evidence of disease for a median of 61 months after HART (range, 36-127 months). Five patients had further manifestations of angiosarcoma after HART at a median of 1 month (range, 1-28 months): 3 with progressive pulmonary and/or mediastinal disease that was likely present before HART and 2 with local or regional disease extension. Progression-free survival rates for the 14 patients at 2 years and 5 years were 71% and 64%, respectively. The overall and cause-specific survival rates were both 86% at 2 years and 5 years.
To the best of the authors' knowledge, HART with or without subsequent surgery, as documented in the current series, is the first approach to provide a high rate of local control, disease-free survival, and overall survival after the development of post-BCT angiosarcoma. The authors believe the success noted with this approach is related to both the hyperfractionation and acceleration of the RT.
随着保乳治疗（BCT）成为非浸润性和早期浸润性乳腺癌患者的标准治疗方法，一小部分患者出现了 BCT 后血管肉瘤。大多数治疗干预都没有成功。据作者所知，迄今为止，医学文献中尚未就这种恶性肿瘤的治疗达成共识。目前的研究旨在报告一种使用超分割和加速放疗（HART）治疗 BCT 后发生的血管肉瘤的新方法的长期结果。
作者回顾性分析了 1997 年 11 月至 2006 年 3 月期间在佛罗里达大学接受 HART 治疗（或不接受手术）的 14 例因 BCT 后发生血管肉瘤的患者的结果。
在最后一次随访时，9 例患者在 HART 后中位时间为 61 个月（范围为 36-127 个月）时持续无疾病证据。5 例患者在 HART 后中位时间为 1 个月（范围为 1-28 个月）时出现进一步的血管肉瘤表现：3 例伴进展性肺和/或纵隔疾病，可能在 HART 前就存在；2 例伴局部或区域疾病扩展。14 例患者的无进展生存率在 2 年和 5 年时分别为 71%和 64%。2 年和 5 年时的总生存率和病因特异性生存率均为 86%。
据作者所知，当前系列研究中记录的 HART 治疗（或随后手术）是在出现 BCT 后血管肉瘤后提供高局部控制率、无疾病生存率和总生存率的第一种方法。作者认为，这种方法的成功与放疗的超分割和加速有关。
