Angiosarcoma of the liver after multimodality therapy for gallbladder carcinoma

Abstract

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.