Radiation-Induced Angiosarcoma of the Breast: A Systematic Review and Meta-Analysis

INTRODUCTION: The purpose of this study is to summarize the totality of evidence on Radiation Induced Angiosarcoma (RIAS) of the breast through a meta-analysis and systematic literature review to assess overall survival (OS), recurrence, mortality, and prognostic factors. METHODS: A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Patient demographics, index cancer, and RIAS characteristics, recurrence, and mortality data were collected. Univariate and multivariate statistical analysis were performed. Kaplan-Meier analysis was used to plot survival probabilities and log-rank statistics to determine radiation cutoff dose. RESULTS: Full-text review identified 201 studies that reported patient-specific data for 531 individual patients. The median age of RIAS diagnosis was 70. The median latency period, from index breast cancer to RIAS diagnosis, was 6.7 years. A recurrence rate of 48.13% was identified. Index breast cancer tumor size was significantly larger in patients who died vs survived (3 cm vs 2 cm, p = 0.028). A threshold radiation dose of 59 Gray was associated with decreased survival probability, p = 0.047 (Figure 1). The latency period was significantly longer for patients who received chemotherapy for their index breast cancer (90.6 vs 72.0 months, p = 0.024). Use of reirradiation as treatment for RIAS did not confer a significant mortality benefit or decrease recurrence. The 5-year overall survival was 55%.Figure 1CONCLUSION: RIAS of the breast is a highly morbid disease. Tumor size, index radiation dose, and chemotherapy use are prognostic factors of RIAS recurrence and mortality. Further research into effective treatment modalities is necessary.