Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong; Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong.
Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong; Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong.
Clin Oncol (R Coll Radiol). 2019 Apr;31(4):225-231. doi: 10.1016/j.clon.2019.01.009. Epub 2019 Feb 6.
Secondary angiosarcoma is known to be associated with lymphoedema or radiation after cancer treatment. This systematic review aims to evaluate the clinical features and outcomes of secondary angiosarcoma commonly arising after breast cancer treatment.
A systematic review was carried out according to the PRISMA protocol. Medline, EMBASE, CINAHL and Cochrane databases were searched for English articles to April 2018 with predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by two researchers.
There were 72 secondary angiosarcomas of the limbs. Most patients (n = 68, 94.4%) had a history of lymphoedema. The median latent period was 15 years (range 3-40 years). Thirty-eight (52.8%) patients received wide excision or amputation as a treatment for the angiosarcoma, two (2.8%) patients received isolated limb perfusion and one (1.4%) patient received systemic chemotherapy. The remaining patients received palliative care/undocumented treatment. The pooled median duration to mortality was 10.5 months (range 1-144 months). Of note, obesity was documented in seven (9.7%) patients. There were 83 breast angiosarcomas; all with known breast cancer history. Thirty-one (37.3%) patients received mastectomy as breast cancer treatment. Fifty-four (65.1%) patients had a history of adjuvant radiotherapy for the primary breast cancer. The median latent period was 6 years (range 2-50 years); the median size was 40 mm (range 8-200 mm). Forty-one (49.4%) patients received wide excision, 19 (22.9%) patients received completion mastectomy and 23 (27.7%) patients have undocumented treatment for angiosarcoma. The pooled median duration to mortality was 31 months (range 6-168 months).
Angiosarcoma in lympedematous upper limbs or after breast cancer irradiation remains uncommon. However, its long latency and high mortality warrant long-term vigilant surveillance.
继发性血管肉瘤已知与癌症治疗后的淋巴水肿或放疗有关。本系统评价旨在评估常见于乳腺癌治疗后的继发性血管肉瘤的临床特征和结局。
根据 PRISMA 方案进行系统评价。检索了 Medline、EMBASE、CINAHL 和 Cochrane 数据库中 2018 年 4 月前发表的英文文章，使用预定义的策略进行检索。对检索到的研究进行独立筛选和相关性评估。由两名研究人员提取数据。
共发现 72 例肢体继发性血管肉瘤。大多数患者（n=68，94.4%）有淋巴水肿病史。潜伏期中位数为 15 年（范围 3-40 年）。38 例（52.8%）患者接受广泛切除或截肢作为血管肉瘤的治疗，2 例（2.8%）患者接受孤立肢体灌注，1 例（1.4%）患者接受全身化疗。其余患者接受姑息治疗/未记录的治疗。汇总的中位死亡时间为 10.5 个月（范围 1-144 个月）。值得注意的是，7 例（9.7%）患者有肥胖记录。有 83 例乳腺血管肉瘤；均有已知的乳腺癌病史。31 例（37.3%）患者接受乳房切除术作为乳腺癌治疗。54 例（65.1%）患者在原发性乳腺癌中接受过辅助放疗。潜伏期中位数为 6 年（范围 2-50 年）；中位大小为 40mm（范围 8-200mm）。41 例（49.4%）患者接受广泛切除术，19 例（22.9%）患者接受根治性乳房切除术，23 例（27.7%）患者未接受血管肉瘤治疗。汇总的中位死亡时间为 31 个月（范围 6-168 个月）。
淋巴水肿上肢或乳腺癌放疗后的血管肉瘤仍然少见。然而，其潜伏期长、死亡率高，需要长期警惕监测。
