Wong Han Hsi, Cojocaru Elena, Watkins James, James Sujil, Aloysius Tony, Harrington Jennifer, Horan Gail, Hatcher Helen
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
Breast Cancer. 2024 Mar;31(2):272-282. doi: 10.1007/s12282-023-01535-5. Epub 2023 Dec 26.
Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer.
Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
22 patients were identified between 2010 and 2022. Median age of diagnosis was 65 years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5 years (range 2.4-16.0)-this interval has decreased over the last 24 years (r = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28 months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65 months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72 years had a median OS of 45 months vs 102 months for those ≤ 72 years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086).
RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.
放射性血管肉瘤（RIA）是乳腺癌放疗后一种罕见但严重的并发症。
对英国东部地区治疗中心剑桥大学医院（CUH）的乳腺RIA患者进行回顾性分析。
2010年至2022年间共确定了22例患者。诊断时的中位年龄为65岁（范围41 - 78岁）。从乳腺放疗到RIA诊断的中位时间为6.5年（范围2.4 - 16.0年）——在过去24年中这一间隔时间有所缩短（r = 0.6601）。9%的患者在初诊时已有转移。所有患者均接受了手术（55%在CUH，45%在当地医院）。27%的患者在一线治疗中接受了围手术期聚乙二醇化脂质体阿霉素治疗。62%的患者在进行了旨在治愈的初次治疗后，中位28个月后复发。36%发生转移，最常见的部位是肺（100%）和淋巴结（50%）。所有患者的2年和5年总生存率（OS）分别为73%和60%。未发现无进展生存期（PFS）和OS与肿瘤大小、切缘、围手术期化疗以及手术是否在CUH进行之间存在相关性。与单病灶疾病相比，乳房有多灶性疾病的患者术后PFS较短（中位时间分别为10个月和65个月；HR = 4.359 [95% CI 1.342 - 14.16]；P = 0.0143）。年龄>72岁的患者中位OS为45个月，而年龄≤72岁的患者为102个月（HR = 7.129 [95% CI 1.646 - 30.88]；P = 0.0086）。
RIA具有高复发率和死亡率，且似乎在乳腺放疗后出现得更早。有必要对其发病机制和有效治疗进行进一步研究。
