Angiosarcoma of the breast: a new therapeutic approach?

Abstract

Introduction: Angiosarcomas are highly malignant endothelial cell tumors with poor prognosis. These can be due to breast cancer itself or to subsequent therapeutic modalities. No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas.

Presentation of the case: We report the case of a 76-year-old woman who developed an exuberant and aggressive post radiation angiosarcoma of the breast and discuss different aspects of therapy for this disease. A total left mastectomy was performed, followed by a right mastectomy. The lesions into the chest wall, and multiple abdominal skin nodules were treated with local Electrochemotherapy (ECT) with intravenous bleomicin.

Discussion: No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Electrochemotherapy (ECT) is an efficient palliative treatment of cutaneous and subcutaneous tumor nodules. It consists of the combination of a cytotoxic drug and electroporation, using appropriate electrical parameters; destabilization of the membrane is reversible, ensuring a high survival of permeabilized cells and the delivery of non-permeant molecules inside the cell.

Conclusion: Due to the rarity of the disease, prospective studies concerning adjuvant or neoadjuvant therapy are limited and no evidence-based guidelines exist. The response to chemotherapy seems to be poor. Treatment with ECT in addition to systemic chemotherapy achieves a complete response in all the lesions and improving patient body image perception.

Keywords: Angiosarcoma; Breast; Electrochemotherapy.

Fig. 1

Multi-nodular mass occupying the entire left breast.

Fig. 2

Electrochemoterapy of multiple thoracic skin nodules, the needles are inserted into the lesion and electric pulses are delivered after intravenous injection of bleomycin.

Fig. 3

Multiple neoplastic abdominal skin nodules.

Fig. 4

Complete response and no relapses is observed 18 months after Eletrochemoterapy.