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Published in: World Journal of Surgical Oncology 1/2024

Open Access 21-02-2024 | Breast Cancer | Case Report

Radiation-induced cutaneous vasculopathy of the breast: a rare case report

Authors: Hilde Van Parijs, Yves Sinove, Marilyn Carprieaux, Mark De Ridder

Published in: World Journal of Surgical Oncology | Issue 1/2024

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Abstract

Background

Radiation therapy is often indicated as part of the treatment for breast cancer and is therefore used frequently worldwide. Vasculopathy is a general term used to describe any condition that affects blood vessels. We present a case report of a patient who presented with vasculopathy as a rare late side effect of radiation therapy to the breast.

Case presentation

This 66-year-old woman was initially treated with breast-conserving surgery for early-stage receptor-positive left breast carcinoma. She received postoperative radiation therapy and hormonal treatment with tamoxifen. She developed sudden spontaneous painless ecchymosis spread over the whole irradiated area 1.5 years after finishing her radiation therapy. Tumor relapse was excluded. There was no associated vasculitis. The cause was presumed to be multifactorial. She had a history of smoking and was known to have hyperlipidemia. She had undergone several surgical treatments at the left breast one year after her initial breast-conserving treatment and was taking tamoxifen. Anti-inflammatory medicine and treatments increasing local blood flow were prescribed. The ecchymosis resolved completely within one month.

Conclusions

Vasculopathy can occur as a rare late side effect of radiation therapy. It can be reversible. Prevention begins with carefully treating precipitating factors.
Literature
1.
go back to reference Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, et al. Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8:145–52.CrossRefPubMed Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, et al. Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8:145–52.CrossRefPubMed
2.
go back to reference Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, et al. Postmastectomy Radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016;34:4431–42.CrossRefPubMed Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, et al. Postmastectomy Radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016;34:4431–42.CrossRefPubMed
3.
go back to reference Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, et al. Primary breast cancer: ESMO Clinical Practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v8–v30.CrossRefPubMed Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, et al. Primary breast cancer: ESMO Clinical Practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v8–v30.CrossRefPubMed
4.
go back to reference Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98.CrossRefPubMed Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98.CrossRefPubMed
5.
go back to reference Dorresteijn LD, Kappelle AC, Scholz NM, Munneke M, Scholma JT, et al. Increased carotid wall thickening after radiotherapy on the neck. Eur J Cancer. 2005;41:1026–30.CrossRefPubMed Dorresteijn LD, Kappelle AC, Scholz NM, Munneke M, Scholma JT, et al. Increased carotid wall thickening after radiotherapy on the neck. Eur J Cancer. 2005;41:1026–30.CrossRefPubMed
6.
go back to reference Ullrich NJ, Robertson R, Kinnamon DD, Scott RM, Kieran MW, et al. Moyamoya following cranial irradiation for primary brain tumors in children. Neurology. 2007;68:932–8.CrossRefPubMed Ullrich NJ, Robertson R, Kinnamon DD, Scott RM, Kieran MW, et al. Moyamoya following cranial irradiation for primary brain tumors in children. Neurology. 2007;68:932–8.CrossRefPubMed
7.
go back to reference Stewart FA, Heeneman S, Te Poele J, Kruse J, Russell NS, et al. Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/- mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage. Am J Pathol. 2006;168:649–58.CrossRefPubMedPubMedCentral Stewart FA, Heeneman S, Te Poele J, Kruse J, Russell NS, et al. Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/- mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage. Am J Pathol. 2006;168:649–58.CrossRefPubMedPubMedCentral
8.
go back to reference Gaya AM, Ashford RF. Cardiac complications of radiation therapy. Clin Oncol (R Coll Radiol). 2005;17:153–9.CrossRefPubMed Gaya AM, Ashford RF. Cardiac complications of radiation therapy. Clin Oncol (R Coll Radiol). 2005;17:153–9.CrossRefPubMed
9.
go back to reference Silverberg GD, Britt RH, Goffinet DR. Radiation-induced carotid artery disease. Cancer. 1978;41:130–7.CrossRefPubMed Silverberg GD, Britt RH, Goffinet DR. Radiation-induced carotid artery disease. Cancer. 1978;41:130–7.CrossRefPubMed
10.
go back to reference Wang C, Roberts KB, Bindra RS, Chiang VL, Yu JB. Delayed cerebral vasculopathy following cranial radiation therapy for pediatric tumors. Pediatr Neurol. 2014;50:549–56.CrossRefPubMed Wang C, Roberts KB, Bindra RS, Chiang VL, Yu JB. Delayed cerebral vasculopathy following cranial radiation therapy for pediatric tumors. Pediatr Neurol. 2014;50:549–56.CrossRefPubMed
11.
go back to reference Fischer-Dzoga K, Dimitrievich GS, Griem ML. Differential radiosensitivity of aortic cells in vitro. Radiat Res. 1984;99:536–46.ADSCrossRefPubMed Fischer-Dzoga K, Dimitrievich GS, Griem ML. Differential radiosensitivity of aortic cells in vitro. Radiat Res. 1984;99:536–46.ADSCrossRefPubMed
12.
go back to reference Paris F, Fuks Z, Kang A, Capodieci P, Juan G, et al. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science. 2001;293:293–7.CrossRefPubMed Paris F, Fuks Z, Kang A, Capodieci P, Juan G, et al. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science. 2001;293:293–7.CrossRefPubMed
13.
go back to reference Reinhold HS, Calvo W, Hopewell JW, Van Den Breg AP. Development of blood vessel-related radiation damage in the fimbria of the central nervous system. Int J Radiat Biol Phys. 1990;18:37–42.CrossRef Reinhold HS, Calvo W, Hopewell JW, Van Den Breg AP. Development of blood vessel-related radiation damage in the fimbria of the central nervous system. Int J Radiat Biol Phys. 1990;18:37–42.CrossRef
14.
go back to reference Venkatesulu BP, Mahadevan LS, Aliru M, Yang X, Bodd MH, et al. Radiation-induced endothelial vascular injury: a review of possible mechanisms. JACC Basic Transl Sci. 2018;3:563–72.CrossRefPubMedPubMedCentral Venkatesulu BP, Mahadevan LS, Aliru M, Yang X, Bodd MH, et al. Radiation-induced endothelial vascular injury: a review of possible mechanisms. JACC Basic Transl Sci. 2018;3:563–72.CrossRefPubMedPubMedCentral
15.
go back to reference Hatoum OA, Otterson MF, Kopelman D, Miura H, Sukhotnik I, et al. Radiation induces endothelial dysfunction in murine intestinal arterioles via enhanced production of reactive oxygen species. Arterioscler ThrombVasc Biol. 2006;26:287–94.CrossRef Hatoum OA, Otterson MF, Kopelman D, Miura H, Sukhotnik I, et al. Radiation induces endothelial dysfunction in murine intestinal arterioles via enhanced production of reactive oxygen species. Arterioscler ThrombVasc Biol. 2006;26:287–94.CrossRef
16.
go back to reference Robbins MEC, Zhao W. Chronic oxidative stress and radiation-induced late normal tissue injury: a review. Int J Radiat Biol Phys. 2004;80:251–9.CrossRef Robbins MEC, Zhao W. Chronic oxidative stress and radiation-induced late normal tissue injury: a review. Int J Radiat Biol Phys. 2004;80:251–9.CrossRef
17.
go back to reference Victor VM, Rocha M, Solá E, Bañuls C, Garcia-Malpartida K, Hernández-Mijares A. Oxidative stress, endothelial dysfunction and atherosclerosis. Curr Pharm Des. 2009;15:2988–3002.CrossRefPubMed Victor VM, Rocha M, Solá E, Bañuls C, Garcia-Malpartida K, Hernández-Mijares A. Oxidative stress, endothelial dysfunction and atherosclerosis. Curr Pharm Des. 2009;15:2988–3002.CrossRefPubMed
18.
go back to reference Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol. 2003;23:168–75.CrossRefPubMed Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol. 2003;23:168–75.CrossRefPubMed
19.
go back to reference Panés J, Anderson DC, Miyasaka M, Granger DN. Role of leukocyte-endothelial cell adhesion in radiation-induced microvascular dysfunction in rats. Gastroenterology. 1995;108:1761–9.CrossRefPubMed Panés J, Anderson DC, Miyasaka M, Granger DN. Role of leukocyte-endothelial cell adhesion in radiation-induced microvascular dysfunction in rats. Gastroenterology. 1995;108:1761–9.CrossRefPubMed
20.
go back to reference Gaugler MH, Squiban C, van der Meeren A, Bertho JM, Vandamme M, Mouthon MA. Late and persistent upregulation of intercellular adhesion molecule-1 (ICAM-1) expression by ionizing radiation in human endothelial cells in vitro. Int J Radiat Biol Phys. 1997;72:201–9.CrossRef Gaugler MH, Squiban C, van der Meeren A, Bertho JM, Vandamme M, Mouthon MA. Late and persistent upregulation of intercellular adhesion molecule-1 (ICAM-1) expression by ionizing radiation in human endothelial cells in vitro. Int J Radiat Biol Phys. 1997;72:201–9.CrossRef
21.
go back to reference Gaugler MH, Squiban C, Mouthon MA, Gourmelon P, van der Meeren A. Irradiation enhances the support of hemopoietic cell transmigration, proliferation and differentiation by endothelial cells. Br J Hematol. 2001;113:940–50.CrossRef Gaugler MH, Squiban C, Mouthon MA, Gourmelon P, van der Meeren A. Irradiation enhances the support of hemopoietic cell transmigration, proliferation and differentiation by endothelial cells. Br J Hematol. 2001;113:940–50.CrossRef
22.
go back to reference Vereycken-Holler V, Aigueperse J, Gaugler MH. Radiation effects on circulating and endothelial cell interactions studied by quantitative real-time videomicroscopy. Int J Radiat Biol Phys. 2002;78:923–30.CrossRef Vereycken-Holler V, Aigueperse J, Gaugler MH. Radiation effects on circulating and endothelial cell interactions studied by quantitative real-time videomicroscopy. Int J Radiat Biol Phys. 2002;78:923–30.CrossRef
23.
go back to reference Quarmby S, Kumar P, Kumar S. Radiation-induced normal tissue injury: role of adhesion molecules in leukocyte-endothelial cell interactions. Int J Cancer. 1999;82:385–95.CrossRefPubMed Quarmby S, Kumar P, Kumar S. Radiation-induced normal tissue injury: role of adhesion molecules in leukocyte-endothelial cell interactions. Int J Cancer. 1999;82:385–95.CrossRefPubMed
24.
go back to reference Salame MY, Verheye S, Mulkey SP, Chronos NA, King SB 3rd, et al. The effect of endovascular irradiation on platelet recruitment at sites of balloon angioplasty in pig coronary arteries. Circulation. 2000;101:1087–90.CrossRefPubMed Salame MY, Verheye S, Mulkey SP, Chronos NA, King SB 3rd, et al. The effect of endovascular irradiation on platelet recruitment at sites of balloon angioplasty in pig coronary arteries. Circulation. 2000;101:1087–90.CrossRefPubMed
25.
go back to reference Halle M, Gabrielsen A, Paulsson-Berne G, Gahm C, Agardh HE, et al. Sustained inflammation due to nuclear factor-kappa B activation in irradiated human arteries. J Am Coll Cardiol. 2010;55:1227–36.CrossRefPubMed Halle M, Gabrielsen A, Paulsson-Berne G, Gahm C, Agardh HE, et al. Sustained inflammation due to nuclear factor-kappa B activation in irradiated human arteries. J Am Coll Cardiol. 2010;55:1227–36.CrossRefPubMed
26.
go back to reference Collins T, Read MA, Neish AS, Whitley MZ, Thanos D, Maniatis T. Transcriptional regulation of endothelial cell adhesion molecules: NF-kappa B and cytokine-inducible enhancers. FASEB J. 1995;9:899–909.CrossRefPubMed Collins T, Read MA, Neish AS, Whitley MZ, Thanos D, Maniatis T. Transcriptional regulation of endothelial cell adhesion molecules: NF-kappa B and cytokine-inducible enhancers. FASEB J. 1995;9:899–909.CrossRefPubMed
27.
go back to reference Hopewell JW. Radiation biology in cancer research. New York: Raven Press: R. E. Meys and H. R. Withers; 1980. p. 449–59. Hopewell JW. Radiation biology in cancer research. New York: Raven Press: R. E. Meys and H. R. Withers; 1980. p. 449–59.
28.
go back to reference Fajardo LV. Principles and practice of radiation oncology. 2nd ed. Philadelphia: J. B. Lippincott. Co; 1992. p. 114–23. Fajardo LV. Principles and practice of radiation oncology. 2nd ed. Philadelphia: J. B. Lippincott. Co; 1992. p. 114–23.
29.
go back to reference Hopewell JW, Young CM. Changes in the microcirculation of normal tissues after irradiation. Int J Radiat Oncol Bio Phys. 1978;4:53–8.CrossRef Hopewell JW, Young CM. Changes in the microcirculation of normal tissues after irradiation. Int J Radiat Oncol Bio Phys. 1978;4:53–8.CrossRef
30.
go back to reference Fajardo LF. The pathology of ionizing radiation as defined by morphologic patterns. Acta Oncol. 2005;44:13–22.CrossRefPubMed Fajardo LF. The pathology of ionizing radiation as defined by morphologic patterns. Acta Oncol. 2005;44:13–22.CrossRefPubMed
31.
go back to reference Thames HD Jr, Withers HR, Peters LJ, Fletcher GH. Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys. 1982;8:219–26.CrossRefPubMed Thames HD Jr, Withers HR, Peters LJ, Fletcher GH. Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys. 1982;8:219–26.CrossRefPubMed
32.
go back to reference Fowler JF. The first James Kirk memorial lecture. What next in fractionated radiotherapy? Br J Cancer. 1984;6 Suppl:285–300. Fowler JF. The first James Kirk memorial lecture. What next in fractionated radiotherapy? Br J Cancer. 1984;6 Suppl:285–300.
33.
go back to reference Murphy ES, Xie H, Merchant TE, Yu JS, Chao ST, Suh JH. Review of cranial radiotherapy-induced vasculopathy. J Neurooncol. 2015;122:421–9.CrossRefPubMed Murphy ES, Xie H, Merchant TE, Yu JS, Chao ST, Suh JH. Review of cranial radiotherapy-induced vasculopathy. J Neurooncol. 2015;122:421–9.CrossRefPubMed
34.
go back to reference Chon BH, Loeffler JS. The effect of nonmalignant systemic disease on tolerance to radiation therapy. Oncologist. 2002;7:136–43.CrossRefPubMed Chon BH, Loeffler JS. The effect of nonmalignant systemic disease on tolerance to radiation therapy. Oncologist. 2002;7:136–43.CrossRefPubMed
35.
go back to reference Herold DM, Hanlon AL, Hanks GE. Diabetes mellitus: a predictor for late radiation morbidity. Int J Radiat Oncol Biol Phys. 1999;43:475–9.CrossRefPubMed Herold DM, Hanlon AL, Hanks GE. Diabetes mellitus: a predictor for late radiation morbidity. Int J Radiat Oncol Biol Phys. 1999;43:475–9.CrossRefPubMed
36.
go back to reference Lin A, Abu-Isa E, Griffith KA, ben-Josef E. Toxicity of radiotherapy in patients with collagen vascular disease. Cancer. 2008;113:648–53.CrossRefPubMed Lin A, Abu-Isa E, Griffith KA, ben-Josef E. Toxicity of radiotherapy in patients with collagen vascular disease. Cancer. 2008;113:648–53.CrossRefPubMed
Metadata
Title
Radiation-induced cutaneous vasculopathy of the breast: a rare case report
Authors
Hilde Van Parijs
Yves Sinove
Marilyn Carprieaux
Mark De Ridder
Publication date
21-02-2024
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2024
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-024-03346-0

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