Donovan Elysia K, Corbett Thomas, Vansantvoort Jasmin, Kak Ipshita, Popvic Snezana, Heller Barbara
Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada.
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
Breast J. 2018 May;24(3):245-252. doi: 10.1111/tbj.12886. Epub 2017 Aug 27.
Radiation-associated angiosarcomas (RAS) of the breast are vascular tumors arising in a previous radiation field for primary breast cancer. They occur rarely but confer a high probability of local recurrence (LR) and poor prognosis. A wide range of treatment strategies exists due to limited evidence, and although resection is the definitive treatment, LR rates remain high. It has been suggested hyperfractionated accelerated radiotherapy (HART) has the potential to prevent LR. The sarcoma group at the Juravinski Cancer Centre (JCC) reports our experience of nine patients treated with radical resection and adjuvant HART. This is one of the largest reported cohorts we are aware of to receive this treatment. The JCC pathologic data base was reviewed between the year 2006-2015 for patients with RAS. Patients who received radical surgery and immediate HART were eligible. Patients underwent radical chest wall resection and en bloc mastectomy. Radiotherapy was then delivered to 4500 cGy in 45 fractions three times daily using parallel opposed photon beams and electron patching, or volumetric modulated arc therapy. Primary outcome was recurrence-free survival in months, and records were reviewed for descriptive reports of toxicity. We compared our results to other institutions experience with surgery alone or other adjuvant therapies. Median follow-up was 19 months (range 3-41 months). One of nine patients developed LR and developed metastasis, one died of other causes, and seven are alive with no recurrent disease. There were seven reports of mild skin toxicity during treatment. One patient developed chronic wound healing complications which eventually resolved and one patient developed asymptomatic radiation osteitis of a rib. On the basis of our experience at the JCC, we recommend treatment with radical chest wall resection and adjuvant HART to prevent recurrence in RAS patients. As demonstrated in our patients, the large normal tissue volume irradiated is tolerable with in combination with small fraction sizes, and no major toxicities were seen. Further investigation into adjuvant therapy regimens and prospective studies are required to reach consensus on optimal treatment for this disease.
乳腺放射性相关血管肉瘤（RAS）是发生在原发性乳腺癌既往放疗区域的血管性肿瘤。它们很少见，但局部复发（LR）概率高且预后差。由于证据有限，存在多种治疗策略，虽然手术切除是确定性治疗，但LR率仍然很高。有人提出超分割加速放疗（HART）有可能预防LR。朱拉温斯基癌症中心（JCC）的肉瘤小组报告了我们对9例接受根治性切除和辅助HART治疗患者的经验。这是我们所知接受这种治疗的最大报告队列之一。回顾了JCC病理数据库2006年至2015年期间RAS患者的情况。接受根治性手术和即刻HART的患者符合条件。患者接受根治性胸壁切除和整块乳房切除术。然后使用平行相对光子束和电子补量或容积调强弧形放疗，分45次，每天3次给予4500 cGy放疗。主要结局是无复发生存月数，并审查记录以获取毒性描述报告。我们将我们的结果与其他机构单独手术或其他辅助治疗的经验进行了比较。中位随访时间为19个月（范围3至41个月）。9例患者中有1例发生LR并出现转移，1例死于其他原因，7例存活且无复发性疾病。治疗期间有7例报告有轻度皮肤毒性。1例患者出现慢性伤口愈合并发症，最终得以解决，1例患者出现肋骨无症状放射性骨炎。根据我们在JCC的经验，我们建议采用根治性胸壁切除和辅助HART治疗以预防RAS患者复发。正如我们的患者所示，照射的正常组织体积大，但与小分割剂量联合时是可耐受的，且未观察到重大毒性。需要进一步研究辅助治疗方案并进行前瞻性研究，以就该疾病的最佳治疗达成共识。
