Local therapy for radiotherapy-associated angiosarcoma of the breast after organ-sparing treatment of primary breast cancer patients. A report of two cases and review of therapeutic options

Radiotherapy-associated angiosarcoma of the breast in breast cancer patients is a rare, poor-prognosis malignancy. Surgical resection with mastectomy is the standard local treatment for this disease. We present two cases of localized secondary angiosarcoma of the breast following breast-conserving therapy for early breast cancer, who underwent salvage mastectomy with R0 resection, followed by chemotherapy in one case. Both patients developed thoracic wall recurrence, and received palliative radio- and chemotherapy. In 23 months after being diagnosed with angiosarcoma, they died of uncontrolled local and distant disease. Our cases confirmed the high risk of local failure after salvage mastectomy due to radiotherapy-induced angiosarcoma. Based on literature, better local control might be achieved with more aggressive surgical approach with excision of all irradiated skin and soft tissue, and with re-irradiation.