Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano.
Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Prato.
ESMO Open. 2024 Jun;9(6):103474. doi: 10.1016/j.esmoop.2024.103474. Epub 2024 Jun 3.
We report on a series of consecutive patients with localized radiation-associated angiosarcoma (RAAS) of the breast region (BR) treated at two Italian sarcoma reference centers.
We retrospectively reviewed all cases of primary, localized, resectable RAAS of the BR, treated at one of the two participating institutions from 2000 to 2019. Relapse-free survival (RFS) and overall survival (OS) were calculated. The prognostic role of several variables was investigated. A propensity score matched (PSM) analysis was carried out.
Eighty-four patients were retrospectively identified. Nineteen out of 84 patients (22.6%) were pretreated with an anthracycline-based regimen for previous cancer. All patients but one underwent surgery, with 37/84 (44.1%) receiving surgery alone and 46/84 (54.8%) a multimodal approach: 18/84 (21.4%) received radiation therapy (RT) and 46/84 (54.9%) received chemotherapy. An anthracycline-based regimen was used in 10/84 patients (11.9%), while a gemcitabine-based regimen was used in 33/84 (39.3%). With a median follow-up of 51 months (interquartile range: 30-126 months), 36/84 patients (42.9%) relapsed and 35/84 patients (41.7%) died (8/84, 9.5% in the lack of metastatic disease). Five-year OS and 5-year RFS were 57% [95% confidence interval (CI) 43% to 68%] and 52% (95% CI 39% to 63%), respectively. Both (neo)adjuvant RT and chemotherapy were associated with better RFS [hazard ratio (HR) 0.25, 95% CI 0.08-0.83; HR 0.45, 95% CI 0.23-0.89] with a trend towards a better OS (HR 0.51, 95% CI 0.18-1.46; HR 0.60, 95% CI 0.29-1.24). Gemcitabine-based regimens seemed to perform better (HR 4.28, 95% CI 1.29-14.14). PSM analysis retained the above results.
This retrospective study supports the use of (neo)adjuvant RT and chemotherapy, in primary, localized resectable RAAS of the BR. An effort to prospectively validate the role of (neo)adjuvant RT and chemotherapy is warranted.
我们报告了在意大利两个肉瘤参考中心治疗的一系列局部放射性相关血管肉瘤（RAAS）的连续患者。
我们回顾性地分析了 2000 年至 2019 年期间在参与研究的两家机构之一治疗的所有原发性、局限性、可切除的 BR 局部 RAAS 病例。计算无复发生存（RFS）和总生存（OS）。研究了多个变量的预后作用。进行了倾向评分匹配（PSM）分析。
共回顾性识别出 84 例患者。84 例患者中有 19 例（22.6%）因先前癌症接受了蒽环类药物为基础的方案治疗。除 1 例患者外，所有患者均接受了手术治疗，其中 37/84（44.1%）单独接受手术，46/84（54.8%）接受多模式治疗：18/84（21.4%）接受放疗（RT），46/84（54.9%）接受化疗。10/84 例（11.9%）患者使用蒽环类药物为基础的方案，33/84 例（39.3%）使用吉西他滨为基础的方案。中位随访时间为 51 个月（四分位间距：30-126 个月），36/84 例（42.9%）患者复发，35/84 例（41.7%）患者死亡（8/84 例，9.5%无转移疾病）。5 年 OS 和 5 年 RFS 分别为 57%（95%CI 43%至 68%）和 52%（95%CI 39%至 63%）。（新）辅助放疗和化疗均与更好的 RFS 相关[风险比（HR）0.25，95%CI 0.08-0.83；HR 0.45，95%CI 0.23-0.89]，并且 OS 有改善的趋势（HR 0.51，95%CI 0.18-1.46；HR 0.60，95%CI 0.29-1.24）。吉西他滨为基础的方案似乎效果更好（HR 4.28，95%CI 1.29-14.14）。PSM 分析保留了上述结果。
这项回顾性研究支持在 BR 的原发性、局限性、可切除的局部 RAAS 中使用（新）辅助放疗和化疗。有必要前瞻性验证（新）辅助放疗和化疗的作用。
