What is your approach to adjuvant systemic therapy for radiation-induced epithelioid angiosarcoma of the chest wall after successful margin-negative resection?

I generally prefer to give neoadjuvant paclitaxel, but in cases such as this where a patient has undergone a margin negative resection, I discuss the limited data supporting adjuvant chemotherapy and after that discussion, will often offer gemcitabine + docetaxel for higher-risk patients, particularly ones with large tumors or with close margins or deep extension of the tumor. Constantinidou et al., PMID 32847839 describes the European use of systemic therapy in the neoadjuvant/adjuvant setting.