Radiation-associated angiosarcoma of the breast: An international multicenter analysis.

INTRODUCTION: Radiation-associated angiosarcoma (RAAS) is a rare and serious complication of breast irradiation. Due to the rarity of the condition, clinical experience is limited and publications on this topic include only retrospective studies or case reports. MATERIALS AND METHODS: All patients diagnosed with RAAS between January 2000 and December 2017 in twelve centers across the Czech Republic and Slovakia were evaluated. RESULTS: Data of 53 patients were analyzed. The median age at diagnosis was 72 (range 44-89) years. The median latency period between irradiation and diagnosis of RAAS was 78 (range 36-172) months. The median radiation dose was 57.6 (range 34-66) Gy. The whole breast radiation therapy with radiation boost to the tumor bed was the most common radiotherapy regimen. Total mastectomy due to RAAS was performed in 43 patients (81%), radical excision in 8 (15%); 2 patients were not surgically treated due to unresectable disease. Adjuvant chemotherapy followed surgical therapy of RAAS in 18 patients, 3 patients underwent adjuvant radiotherapy. The local recurrence rate of RAAS was 43% and the median time from surgery to the onset of recurrence was 7.5 months (range 3-66 months). The 3-year survival rate was 56%, the 5-year survival rate was only 33%. 46% of patients died during the follow-up period. CONCLUSION: The present data demonstrate that RAAS is a rare condition with high local recurrence rate (43%) and mortality (the 5-year survival rate was 33%.). Early diagnosis of RAAS based on biopsy is crucial for treatment with radical intent. Surgery with negative margins constitutes the most important part of the therapy; the role of adjuvant chemotherapy and radiotherapy is still unclear.

[Effect of the gut microbiota on the development of colorectal cancer and leakage of intestinal anastomoses].

Colorectal cancer is a very common malignancy with high mortality. Many factors influencing both the development and subsequent treatment, such as age, gender or genetic predisposition, are not modifiable. Others, such as stress, diet, physical activity or smoking, may be prevented by each individual. The gut microbiota is an important factor involved in both the development and treatment outcomes. With the advancing study of the gut microbiota, the relationship between its composition and various diseases is better understood. The proportions of members of the phyla Firmicutes (as beneficial microbiota) and Bacteroidetes (as mostly disease-associated microbiota) seem to be particularly important. Some studies suggest that certain bacteria may contribute to postoperative anastomotic leaks that prolong hospital stays, are a burden to patients, increase costs and may be fatal. Bacteria associated with the complication are, for example, enterococci, pseudomonads or bifidobacteria. Better understanding of the pathognomonic relationship between increased detection of certain bacteria and a complication may lead to individualized therapy aimed to reduce complications during surgical management of colorectal cancer.