Potential risks and benefits of radiation therapy as adjuvant treatment in patients with low-risk carcinoma of the mammary gland: taking cutaneous postradiation angiosarcoma as an opportunity for a critical appraisal of postoperative radiotherapy.

摘要

In this issue of Annals of Oncology, M. Moe and G. Bertelli propose, in a 'Letter to the Editor', a number of interesting considerations on the clinical pattern and treatment of breast angiosarcoma, with emphasis on a woman presenting this disease after breast-conserving surgery (BCS) and radiotherapy, with a short latent period following her first-line treatment.Their letter first calls for a number of comments on a typical example of radio-induced late effects, the occurrence of which always represents a source of profound frustration both for the patient and her radiation oncologist.As an aggressive tumor of endothelial origin, angiosarcoma of the breast (AS) is occurring as idiopathic, lymphedema-associated, postirradiation, soft tissue, and various other clinical settings [1, 2]. Among these settings, iatrogenic AS, also known as 'Stewart-Treves syndrome' is usually attributed to chronic lymphedema, which can occur in a number of patients treated with BCS. Later on, with emphasis on breast-conservingtherapy combined with adjuvant radiation, a form of cutaneous postradiation angiosarcoma of the breast (CPRASB) emerged from histopathologic reviews . " Characterized by a lack of association with lymphedema, CPRASB is frequently multifocal at presentation, most tumors have a vasoformative, sieve-like pattern of growth, and high-grade nuclear features.