Surgical Management within a Tertiary Referral Service Leads to Improved Disease Specific Survival of Patients with Radiation-associated Angiosarcoma of the Breast
Association of Breast Surgery ePoster Library. Finberg L. 05/15/17; 166252; P020
Mr. Leo Finberg
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Abstract
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Aims: Radiation-associated angiosarcoma of the breast (RAA) is a rare complication of adjuvant radiotherapy and has poor survival. The British Sarcoma Group Guidelines recommend that angiosarcomas are referred to a sarcoma multidisciplinary team, although there is no recommendation that patients are managed within a sarcoma service (SS). The aims were to compare complete excision rate (CER), local recurrence rate (LRR) and survival of RAA patients managed within a SS and those managed locally.
Methods: All patients with RAA referred to our regional SS (University Hospitals Birmingham and Royal Orthopaedic Hospital) between 1998-2016 were identified from prospective databases. Patient records, pathology, and operation notes were reviewed retrospectively. Statistical tests: Mann-Whitney-U (CER and LRR); Kaplan-Meier analyses (survival).
Results: Thirty-six patients were operated on with curative intent; 26 were managed by the SS (81% underwent wide-excision of the angiosarcoma, including most of the irradiated field with chest wall reconstruction) and ten were managed locally. Median age was 70 years (range 43-85). There was no difference in CER (68% by the SS compared to 50% by local services, p=0.456), although LRR was significantly lower in patients managed by the SS (p=0.015). Disease specific survival (DSS) was significantly longer in patients managed by the SS compared to those managed locally; 91.1 months (range 69.2-113) versus 48.8 months (range 18.6-79.1) respectively, p=0.012. There was no difference in overall survival (p=0.112).
Conclusions: Surgical management of RAA within a SS is associated with longer DSS and lower LRR. Early referral and management within a sarcoma-reconstructive service is recommended.
Methods: All patients with RAA referred to our regional SS (University Hospitals Birmingham and Royal Orthopaedic Hospital) between 1998-2016 were identified from prospective databases. Patient records, pathology, and operation notes were reviewed retrospectively. Statistical tests: Mann-Whitney-U (CER and LRR); Kaplan-Meier analyses (survival).
Results: Thirty-six patients were operated on with curative intent; 26 were managed by the SS (81% underwent wide-excision of the angiosarcoma, including most of the irradiated field with chest wall reconstruction) and ten were managed locally. Median age was 70 years (range 43-85). There was no difference in CER (68% by the SS compared to 50% by local services, p=0.456), although LRR was significantly lower in patients managed by the SS (p=0.015). Disease specific survival (DSS) was significantly longer in patients managed by the SS compared to those managed locally; 91.1 months (range 69.2-113) versus 48.8 months (range 18.6-79.1) respectively, p=0.012. There was no difference in overall survival (p=0.112).
Conclusions: Surgical management of RAA within a SS is associated with longer DSS and lower LRR. Early referral and management within a sarcoma-reconstructive service is recommended.
Aims: Radiation-associated angiosarcoma of the breast (RAA) is a rare complication of adjuvant radiotherapy and has poor survival. The British Sarcoma Group Guidelines recommend that angiosarcomas are referred to a sarcoma multidisciplinary team, although there is no recommendation that patients are managed within a sarcoma service (SS). The aims were to compare complete excision rate (CER), local recurrence rate (LRR) and survival of RAA patients managed within a SS and those managed locally.
Methods: All patients with RAA referred to our regional SS (University Hospitals Birmingham and Royal Orthopaedic Hospital) between 1998-2016 were identified from prospective databases. Patient records, pathology, and operation notes were reviewed retrospectively. Statistical tests: Mann-Whitney-U (CER and LRR); Kaplan-Meier analyses (survival).
Results: Thirty-six patients were operated on with curative intent; 26 were managed by the SS (81% underwent wide-excision of the angiosarcoma, including most of the irradiated field with chest wall reconstruction) and ten were managed locally. Median age was 70 years (range 43-85). There was no difference in CER (68% by the SS compared to 50% by local services, p=0.456), although LRR was significantly lower in patients managed by the SS (p=0.015). Disease specific survival (DSS) was significantly longer in patients managed by the SS compared to those managed locally; 91.1 months (range 69.2-113) versus 48.8 months (range 18.6-79.1) respectively, p=0.012. There was no difference in overall survival (p=0.112).
Conclusions: Surgical management of RAA within a SS is associated with longer DSS and lower LRR. Early referral and management within a sarcoma-reconstructive service is recommended.
Methods: All patients with RAA referred to our regional SS (University Hospitals Birmingham and Royal Orthopaedic Hospital) between 1998-2016 were identified from prospective databases. Patient records, pathology, and operation notes were reviewed retrospectively. Statistical tests: Mann-Whitney-U (CER and LRR); Kaplan-Meier analyses (survival).
Results: Thirty-six patients were operated on with curative intent; 26 were managed by the SS (81% underwent wide-excision of the angiosarcoma, including most of the irradiated field with chest wall reconstruction) and ten were managed locally. Median age was 70 years (range 43-85). There was no difference in CER (68% by the SS compared to 50% by local services, p=0.456), although LRR was significantly lower in patients managed by the SS (p=0.015). Disease specific survival (DSS) was significantly longer in patients managed by the SS compared to those managed locally; 91.1 months (range 69.2-113) versus 48.8 months (range 18.6-79.1) respectively, p=0.012. There was no difference in overall survival (p=0.112).
Conclusions: Surgical management of RAA within a SS is associated with longer DSS and lower LRR. Early referral and management within a sarcoma-reconstructive service is recommended.
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