In a patient with solitary metastasis skin/subcutaneous wrist, resected with graft, from a primary breast angiosarcoma, what would be your preferred fields and dose?
50+ yo F. Mastectomy, chemo, and RT in 2016 for primary breast angiosarcoma, not RT induced. Had longstanding cyst on wrist, biopsied, and positive for angiosarcoma. Resection of ~3 cm angiosarcoma, with negative margins. Reconstructed with split thickness skin graft. S/p adjuvant gem and docetaxel chemotherapy.
Answer from: Radiation Oncologist at Academic Institution
Agree, odd presentation. Hopefully, the patient was fully staged with PET and MRI brain after this was diagnosed to confirm solitary metastasis. If so, agree with chemo first; angiosarcoma in general, has formidable DM risk (though hard to know how much that applies to this presentation) so makes se...
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Answer from: Radiation Oncologist at Academic Institution
This is an uncommon patter of distant metastatic spread with long natural history from the original diagnosis. I would consider standard postop (60/30) given single site and 6 years; alternatively, given distant metastatic disease one could consider a hypofractionated regimen, I have used 32-40/8-10...