Angiosarcomas of the breast: a review of 70 cases.

OBJECTIVE: Angiosarcoma arising in the irradiated breast after breast-conserving therapy is being reported with increasing frequency. As more women undergo breast-conserving therapy, the incidence can be expected to increase. The objective of this study was to review breast angiosarcomas diagnosed from 1981 to 2000 from our state cancer registry. METHODS: A comprehensive review of a population-based registry, Florida Cancer Data System, identified 70 cases of breast angiosarcomas from 1981 to 2000. Descriptive statistical and chi analyses were performed. RESULTS: Of the 70 cases at presentation, 39 were primary breast angiosarcomas (PBAs) and 31 were secondary breast angiosarcomas (SBAs). The mean ages were 59 and 72.9 for the PBA and SBA groups, respectively. In the SBA group the mean age of breast cancer diagnosis was 67.6. The mean time to diagnosis of the angiosarcoma was 5.2 years after breast cancer irradiation. At presentation 82% (n = 32) and 48% (n = 15), in the PBA and SBA groups, respectively had local disease (P = 0.003). The primary treatment was mastectomy in each group. There was no difference in mortality between the 2 groups (PSA; n = 18, SBA; n = 17). CONCLUSION: Angiosarcoma of the breast is rare and this study reports a review of 70 cases from 1980 to 2000. Angiosarcoma after breast-conserving therapy is increasingly diagnosed in a small but significant portion of breast carcinoma survivors. SBA patients present with more advance disease. Surgical resection is the primary therapy. The aggressive nature of this disease demands further investigation of adjuvant therapy to prevent recurrence of disease after surgery.

Neoadjuvant, surgery and adjuvant chemotherapy without radiation for esophageal cancer.

BACKGROUND: A phase II trial to evaluate neoadjuvant (NAD), surgery and adjuvant (AD) combination chemotherapy without radiation therapy (RT) for patients with esophageal adenocarcinoma staged with endoscopic ultrasound and CT as T3N1 was carried out. METHODS: Thirty-three eligible patients were enrolled. NAD therapy was administered in two 49-day cycles and included cisplatin, floxuridine, paclitaxel and leucovorin. Esophageal resection was performed followed by AD therapy. RESULTS: Thirty-three patients initiated NAD therapy; 10 experienced grade 3 and 4 toxicities, which included leucopenia, fatigue, nausea, diarrhea and stomatitis. Additionally, 16 patients experienced grade 1 and 2 hematologic and non-hematologic toxicities. Fifteen patients were down-staged, of whom five were T2, seven were T1, and three had nodal disease with no evidence of residual cancer in the esophageal bed. Fifteen patients remained T3, and two showed progressive disease. Thirty-two patients proceeded to surgery and 30 were resected. Although all resected patients were eligible for AD therapy, 15 did not receive it either because of patient refusal or surgeon recommendation. Fifteen patients received AD therapy: nine who had remained T3 and six who had down-staged. Three patients experienced grade 3 and 4 toxicities similar to those in NAD therapy. Six patients had grade 1 and 2 toxicities. Kaplan-Meier estimates of overall survival at 1, 3 and 5 years were 73% (95% CI: 58-88%), 52% (95% CI: 34-69%) and 29% (95% CI: 13-45%), respectively. Median survival was 42 months. CONCLUSION: Deletion of RT may safely allow for more aggressive chemotherapy and increase chances of survival. The results need to be confirmed in a randomized phase II or larger phase III trial.