Management of Localized Breast Angiosarcoma by North American Radiation and Medical Oncologists

Introduction: Primary breast angiosarcoma is a rare malignancy with no clinical trials to guide management. The current use of surgery, chemotherapy, and radiotherapy among North American oncologists is unknown. Patients and Methods: An institutional review board–approved anonymous electronic survey was distributed to 9660 practicing North American radiation and medical oncologists. Questions pertained to treatment recommendations for localized nonmetastatic primary breast angiosarcoma, as well as knowledge/use of β-blockers in angiosarcoma. The Fisher exact test was used to compare responses of medical and radiation oncologists. Results: Surgery was recommended by 95% of all respondents. Chemotherapy was recommended by over half of medical and radiation oncologists. Radiotherapy was recommended by 92% of radiation and 56% of medical oncologists. The most common treatment recommendation was a trimodal treatment, with up-front surgery followed by adjuvant chemotherapy, then by adjuvant radiotherapy. Twenty-two percent of respondents were aware of clinical data pertaining to the use of β-blockers in management of angiosarcoma, and among these respondents 69% were comfortable incorporating this treatment into standard practice. Conclusion: Trimodal management of primary localized breast angiosarcoma is supported by North American radiation and medical oncologists, with the majority recommending up-front surgery followed by adjuvant chemotherapy and radiation. The recently published reports of successful use of β-blockers are not yet known among North American clinicians, but there is a great enthusiasm to incorporate these commonly prescribed medications into standard practice. These findings may greatly influence the standard of care for breast angiosarcoma treatment, particularly given the absence of Level I–supported evidence. To study the current use of surgery, chemotherapy, and radiotherapy (trimodal management), we asked North American radiation and medical oncologists to fill out a questionnaire. Trimodal management of primary localized breast angiosarcoma is supported by these oncologists; most recommend surgery with adjuvant chemotherapy and radiation, with the usefulness of β-blockers remaining unknown. These findings may greatly influence the standard of care for breast angiosarcoma treatment.