Search

Background. Treatment-induced angiosarcoma is a rare complication of cancer therapy and is best known for arising on the chest wall after a mastectomy. We report an unusual case of a treatment-induced angiosarcoma developing in the liver after adjuvant radiotherapy for gallbladder carcinoma. Case report. Radiation-induced angiosarcoma of the liver developed in a 46-year-old woman after radiotherapy for stage IIB (T3N1M0) adenocarcinoma of the gallbladder in 1991. The patient subsequently underwent resection, postoperative external beam radiotherapy, and multiagent chemotherapy. Several severe late adverse effects developed, including duodenal obstruction with fistula formation and chronic mesenteric ischemia secondary to occlusion of the superior mesenteric artery. Six years after her gallbladder resection and adjuvant treatment, a fatal grade 4 of 4 angiosarcoma of the liver developed within the radiation field. Conclusions. To our knowledge, this is the first case of radiation-induced angiosarcoma of the liver after radiotherapy for gallbladder carcinoma. Normal organ dose-volume limits should be considered carefully when delivering a course of external beam radiotherapy in the upper abdomen.

While endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for locoregional staging of esophageal cancer, little evidence exists that these innovations impact on clinical care. The objective on this study was to determine the frequency with which EUS and EUS-FNA alter the management of patients with localized esophageal cancer, and assess practice variation among specialists at a tertiary care center. Three gastroenterologists, three medical oncologists, three radiation oncologists and four thoracic surgeons were asked to independently report their management recommendations as the anonymized staging information of 50 prospectively enrolled patients from another study were sequentially disclosed on-line. Compared to initial management recommendations, that were based upon history, physical examination, upper endoscopy and CT scan results, EUS prompted a change in management 24% (95% CI: 12–36%) of the time; usually to a more resource-intensive approach (71%), for example from recommending palliation to recommending neoadjuvant chemoradiation therapy. EUS-FNA plus cytology results altered management an additional 8% (95% CI: 6–15%) of the time. Agreement between specialists ranged from fair (intraclass correlation [ICC = 0.32) to substantial (ICC = 0.65); improving with additional information. Among specialists, agreement was greatest for patients with stage I disease. EUS and EUS-FNA changed patient management the most for patients with stages IIA, IIB or III disease. EUS, with or without FNA, significantly impacts the management of patients with localized esophageal cancer. With respect to the optimal treatment for each patient, agreement among physicians incrementally increases with endoscopic ultrasound results. Specialty training appears to influence therapeutic decision-making behavior.