ABSTRACT
Post-breast cancer treatment-related angiosarcomas were first observed in lymphedematous extremities after mastectomy and are now being reported with increasing frequency after lumpectomy and radiation. A case history is presented of a BRCA2 carrier who had a postmastectomy chest wall angiosarcoma but had neither therapeutic radiation nor clinically evident lymphedema. The absence of established risk factors led to speculation that the BRCA2 germline mutation could be a causative factor in the development of this patient's angiosarcoma. A literature review supported this concept.
Subject(s)
BRCA2 Protein/genetics , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Germ-Line Mutation , Hemangiosarcoma/genetics , Neoplasms, Second Primary/genetics , Skin Neoplasms/genetics , Adult , Breast Neoplasms/genetics , Carcinoma, Ductal, Breast/genetics , Female , Genetic Predisposition to Disease , Humans , Mastectomy , Neoplasm Recurrence, LocalABSTRACT
BACKGROUND: Two ductal carcinoma in situ (DCIS) treatment controversies are (1) what is the preferred margin for patients undergoing lumpectomy plus radiation, and (2) is there a subgroup that can be safely treated with lumpectomy alone? A multidisciplinary team was established to evaluate these issues. METHODS: Patients with DCIS who were candidates for breast-conservation were divided into 2 groups. Group 1 had a minimum 5-mm margin and received radiation, and group 2 had a minimum 10-mm margin and received no radiation. RESULTS: One hundred fifty-two patients (153 cancers) met the inclusion criteria. The median follow-up was 8.2 years. Overall, there were 6 recurrences (3.92%); 1 of 71 recurred in group 1 (1.40%), and 5 of 82 recurred in group 2 (6.01%). CONCLUSION: Five-millimeter margins plus radiation results in low rates of recurrence. A subgroup of DCIS patients can be identified in which radiation can be safely avoided. The multidisciplinary team approach to managing DCIS enhances the potential for improved outcomes.
