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Yamakawa K, Ogata D, Namikawa K, Nakano E, Yamaguchi Y, Yamazaki N. A review of cutaneous angiosarcoma: epidemiology, diagnosis, prognosis, and treatment options. Jpn J Clin Oncol 2025:hyaf071. [PMID: 40381218 DOI: 10.1093/jjco/hyaf071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/22/2025] [Indexed: 05/20/2025] Open
Abstract
Cutaneous angiosarcoma (cAS) is a rare and aggressive malignant vascular tumor that arises from endothelial cells lining the blood vessels. It can occur in any part of the body, but most commonly, it affects the skin and soft tissues. cAS has a poor prognosis with a 5-year survival rate of only 9%. This review summarizes the current understanding of angiosarcoma pathogenesis, clinical presentation, diagnosis, and treatment approaches. Recent advances in molecular characterization have identified recurrent genetic alterations that may lead to the development of novel targeted therapies. Multidisciplinary management combining surgery, radiation, and systemic therapy remains the mainstay of treatment; however, outcomes remain poor for metastatic disease. Ongoing research into the molecular drivers of cAS and immunotherapeutic approaches offers hope for improving the outcomes of this challenging malignancy.
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Affiliation(s)
- Kohei Yamakawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Eiji Nakano
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Cristescu AN, Dumitrescu I, Tudose I, Beiu C, Dumitrescu AM, Popa LG. Personalized Treatment for Scalp Angiosarcoma. J Clin Med 2025; 14:1278. [PMID: 40004808 PMCID: PMC11856079 DOI: 10.3390/jcm14041278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/09/2025] [Accepted: 02/12/2025] [Indexed: 02/27/2025] Open
Abstract
Cutaneous angiosarcoma is a rare and aggressive malignant tumor that originates from the endothelial cells of blood vessels or lymphatic vessels. More than half of cutaneous angiosarcoma cases occur in the head and neck regions, particularly on the scalp. However, due to its rarity, scalp angiosarcoma is often overlooked in clinical practice. The lack of distinctive symptoms usually delays the diagnosis and, implicitly, the initiation of appropriate treatment. The treatment of cutaneous angiosarcoma poses great challenges due to its multifocal occurrence and the frequent extensive microscopic spread. A personalized, multimodal therapeutic approach is essential for ensuring a favorable outcome, consisting of a wide surgical excision associated with adjuvant radiotherapy in localized tumors, concurrent adjuvant radiotherapy and chemotherapy, targeted treatments, or immunotherapy in advanced or metastatic diseases. The aim of this manuscript is to review the literature data regarding the individualized management of cutaneous angiosarcoma and to share our own experiences in the field. We wish to underscore the importance of considering cutaneous angiosarcoma in the differential diagnosis of scalp tumors, especially in patients with a history of scalp irradiation as early detection, accurate diagnosis, and a multidisciplinary, personalized management, including surgery with clear margins and adjuvant radiation therapy, are crucial for ensuring a favorable outcome.
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Affiliation(s)
- Adriana Nicoleta Cristescu
- Dermatology Department, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania
| | - Ioana Dumitrescu
- General Surgery Department, Prof. Dr. Dimitrie Gerota Emergency Hospital, 29-31 Vasile Vasilievici Stroescu Street, District 2, 021374 Bucharest, Romania
| | - Irina Tudose
- Histopathology Department, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania
| | - Cristina Beiu
- Dermatology Department, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania
- Dermatology Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania
| | | | - Liliana Gabriela Popa
- Dermatology Department, Elias Emergency University Hospital, 17 Marasti Bd., District 1, 011461 Bucharest, Romania
- Dermatology Department, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania
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Zeng D, Wang Z, Feng Y, McKay MJ, Masanam MK, Long H, Cao X. Trends in the incidence, survival, and prognostic nomogram of angiosarcoma in the United States. Medicine (Baltimore) 2025; 104:e41152. [PMID: 40184128 PMCID: PMC11709153 DOI: 10.1097/md.0000000000041152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 12/07/2024] [Accepted: 12/12/2024] [Indexed: 04/05/2025] Open
Abstract
This study aimed to investigate the epidemiological trends of angiosarcoma and to establish a tool to estimate its prognosis. Data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) were used to assess trends in the epidemiology of angiosarcoma, and a nomogram was established based on independent prognostic factors. The age-adjusted incidence of angiosarcoma gradually increased from 0.13/100,000 in 1975 to 0.33/100,000 in 2016 (annual percentage change [2.4]). The most significant increase was observed in patients aged ≥ 60 years. The same increasing trend was observed across all the stages and grades. The limited-duration prevalence increased from 0.0003% in 1992 to 0.0013% in 2016 (P < .05). In multivariable analyses, age, sex, marital status, grade, historical stage, surgery, site, and tumor size were independent prognostic factors for angiosarcoma. The concordance index of the nomogram was significantly higher than that of the American Joint Committee on Cancer (AJCC) 6th edition and the AJCC 7th edition (0.74 vs 0.61 vs 0.66, respectively). Calibration analysis showed optimal agreement between nomogram predictions and actual observations. The incidence and prevalence of angiosarcoma has increased over the past 40 years. We established a nomogram to predict the overall survival of patients with angiosarcoma.
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Affiliation(s)
- Dong Zeng
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhiyi Wang
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yongdong Feng
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Michael J. McKay
- Northern Cancer Service, Northwest Regional Hospital, Burnie, Tasmania, Australia
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Monika K. Masanam
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Haixia Long
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xi Cao
- Department of Medical Engineering, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Kashihara T, Nakamura S, Yamazaki N, Takahashi A, Namikawa K, Ogata D, Nakano E, Okuma K, Kaneda T, Mori T, Ito K, Itami J, Shimada K, Nakagama H, Igaki H. Boron neutron capture therapy for cutaneous angiosarcoma and malignant melanoma: First in-human phase I clinical trial. Radiother Oncol 2025; 202:110607. [PMID: 39489429 DOI: 10.1016/j.radonc.2024.110607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 10/23/2024] [Accepted: 10/25/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND AND PURPOSE Definitive radiotherapy for patients with scalp angiosarcoma has a poor prognosis, often resulting in severe skin adverse events. Additionally, malignant melanoma is known for its radioresistant nature. Boron neutron capture therapy (BNCT) may address these challenges due to the high uptake capacity of boron drugs in these cancer types. We aimed to determine the treatment dose for BNCT and evaluate the incidence of acute adverse events AEs following BNCT in patients with primary or recurrent angiosarcoma/malignant melanoma of the skin. MATERIALS AND METHODS This was a single-center, non-randomized clinical trial with a three-step dose escalation plan, involving maximum skin doses of 12, 15, and 18 Gy-Eq following a 3 + 3 design. The patients underwent BNCT between November 2019 and April 2022. The primary endpoint was to evaluate the incidence of acute adverse events. RESULTS Ten patients (scalp angiosarcomanine, forefinger malignant melanoma: one) were included. The median target lesion size was 46.5 (range: 20-145) mm. A transient asymptomatic increase in serum amylase level was the only grade 3 adverse event. The best overall response rate within 180 days was 70 % (median tumor shrinkage rate: 77.5 % [4.9-100 %]). CONCLUSIONS BNCT with a dose of 18 Gy-Eq is a feasible treatment option, demonstrating a favorable safety profile and a high response rate in patients with primary or recurrent angiosarcoma or malignant melanoma of the skin.
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Affiliation(s)
- Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan; Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Satoshi Nakamura
- Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan; Department of Medical Physics, National Cancer Center Hospital, Tsukiji 5-1-1 Chuo-ku, Tokyo 104-0045, Japan.
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Eiji Nakano
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Kimiteru Ito
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan; Shin-Matsudo Accuracy Radiation Therapy Center, Shin-Matsudo Central General Hospital, 1-380 Shin-Matsudo, Matsudo, Chiba 270-0034, Japan.
| | - Kazuaki Shimada
- National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hitoshi Nakagama
- National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan; Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
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Utikal JS, Wohlfeil SA, Bauer-Auch C, Vogel T, Koy AL, Morakis P. Prognosis of primary cutaneous angiosarcoma versus radiation-induced angiosarcoma: A cohort study. J Eur Acad Dermatol Venereol 2024. [PMID: 39600188 DOI: 10.1111/jdv.20444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024]
Affiliation(s)
- Jochen S Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Sebastian A Wohlfeil
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Christiane Bauer-Auch
- Quality Conferences Office at the Clinical State Registry Baden-Württemberg GmbH of the Baden-Württemberg Cancer Registry, Stuttgart, Germany
| | - Tilo Vogel
- Quality Conferences Office at the Clinical State Registry Baden-Württemberg GmbH of the Baden-Württemberg Cancer Registry, Stuttgart, Germany
| | - Anna-Lena Koy
- Clinical State Registration Office (KLR GmbH) of the Baden-Württemberg Cancer Registry, Stuttgart, Germany
| | - Philipp Morakis
- Quality Conferences Office at the Clinical State Registry Baden-Württemberg GmbH of the Baden-Württemberg Cancer Registry, Stuttgart, Germany
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Kwapnoski Z, Clarey D, Ma J, Schmidt CM, Wysong A. Cutaneous Angiosarcoma Subtypes: A Quantitative Systematic Review of Demographics, Treatments, and Outcomes Within Published Patient-Level Cases. Dermatol Surg 2024; 50:620-626. [PMID: 38530994 DOI: 10.1097/dss.0000000000004174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy arising from the vascular endothelium. Given its rarity, there is insufficient data detailing patient demographics, management, and survival outcomes. OBJECTIVE To systematically compile published patient-level cases of cAS and to quantify and analyze data on demographics, management, and outcomes while determining prognostic indicators. MATERIALS AND METHODS Searches of EBSCOhost, MEDLINE, EMBASE, and the Cochrane Library generated 1,500 cases of cAS with individual level data available. PRISMA guidelines were followed. RESULTS Cutaneous angiosarcoma presented most often on the scalp of elderly men. Metastasis occurred in 36.3% of cases. Aggregate 5-year survival was 31.6% with the median survival of 25 months. The best 5-year survival was in the radiation-associated subtype (48.8%), whereas the worst was in the Stewart-Treves subtype (21.6%). Using multivariate analysis, gender, age group, disease subtype, treatment modality, and metastasis at presentation had significant effects on survival outcomes ( p < .05). CONCLUSION The breadth of information obtained enables this study to serve as a resource that clinicians may reference when they encounter cAS.
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Affiliation(s)
- Zachary Kwapnoski
- Department of Dermatology, University of California Davis, Sacramento, CA
| | - Dillon Clarey
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
| | - Jihyun Ma
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Cynthia M Schmidt
- University of Nebraska, Medical Center, Leon S. McGoogan Health Sciences Library, Omaha, NE
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
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Oon ML, Wu B, Goh JY, Chang KTE, Chong YL, Wong ZW, Oh SY, Tan C, Nga ME, Petersson F. Primary Epithelioid Angiosarcoma of the Submandibular Gland-A Case Report with Histology-Cytology Correlation and Comprehensive Molecular Analysis. Head Neck Pathol 2024; 18:56. [PMID: 38916683 PMCID: PMC11199468 DOI: 10.1007/s12105-024-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Angiosarcoma is a sarcoma that occurs in a range of tissue types, and only rarely in the salivary glands, showing a predilection for the parotid glands of older patients. Preoperative diagnosis may be challenging, especially on cytology, with significant morphological overlap with high-grade primary salivary gland carcinomas. The molecular alterations of this rare salivary gland neoplasm are also not well-characterized. METHODS AND RESULTS We present a case of right submandibular gland swelling in a 73-year-old male. On fine needle aspiration, including immunohistochemical stains on cell block, the tumor was initially diagnosed as poorly differentiated carcinoma. Resection of the submandibular gland revealed epithelioid angiosarcoma. We performed molecular work-up of the tumor, utilizing targeted next-generation sequencing, DNA methylation profiling and fluorescence in-situ hybridization. Histopathologic assessment revealed an infiltrative tumor comprising solid sheets of epithelioid cells. The tumor cells formed haphazardly anastomosing vascular channels with intracytoplasmic lumina containing red blood cells. On immunohistochemistry, the tumor cells were positive for CD31, CD34 and ERG. Approximately 40% of the tumor cells showed nuclear expression of GATA3. A pathogenic TP53 R267W mutation was detected on next-generation sequencing. DNA methylation analysis did not cluster the tumor with any known sarcoma type. Copy number analysis showed possible MYC amplification and CDKN2A losses, although only the latter was confirmed on fluorescence in-situ hybridization. CONCLUSION Epithelioid angiosarcoma is an important differential diagnosis to high-grade salivary gland carcinoma. In particular, GATA3 expression may be encountered in both angiosarcoma and high-grade salivary gland carcinomas and cause diagnostic confusion. Identification of TP53 mutations and CDKN2A losses suggest shared oncogenic pathways with soft tissue angiosarcomas, and should be further investigated.
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Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yan Ling Chong
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Zi Wei Wong
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Shoo Yi Oh
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Charmaine Tan
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Hospital, Singapore, Singapore.
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Evans LK, Sutton S, Echanique K, Armaneous M, Palacios V, Sajed D, St. John M. Cutaneous head and neck angiosarcoma: The 30-year UCLA experience. Laryngoscope Investig Otolaryngol 2023; 8:1557-1563. [PMID: 38130244 PMCID: PMC10731542 DOI: 10.1002/lio2.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Background Cutaneous angiosarcoma is an aggressive tumor commonly found in the head and neck region. There is no consensus regarding the definitive treatment for angiosarcoma. Methods This was a retrospective chart review that evaluated 64 patients from 1983 to 2019. Demographic and clinical variables were examined for impact on recurrence using the time to recurrence and the overall survival in Kaplan-Meier curves. Results Average age at diagnosis was 71 (32-95) years, with a 2.8 male: female ratio. Surgery was utilized in 62% of patients, with mean defect size of 11.4 ± 8.1 cm. Recurrence was found in 70% of patients, and mean time to recurrence was 15.3 ± 12.3 months. Decreased recurrence was associated with use of intraoperative frozen section analysis (p = .036) and negative margins (p = .086). Two-year overall survival was 80%, and recurrence free survival was 30%. Conclusions Negative margins are associated with decreased recurrence, and intraoperative frozen section analysis may be considered to obtain preliminary surgical margins.Level of Evidence: 4.
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Affiliation(s)
- Lauran K. Evans
- David Geffen School of Medicine at UCLA—Department of Head & Neck SurgeryLos AngelesCaliforniaUSA
| | - Sarah Sutton
- School of MedicineUniversity of Nevada, RenoRenoNevadaUSA
| | - Kristen Echanique
- David Geffen School of Medicine at UCLA—Department of Head & Neck SurgeryLos AngelesCaliforniaUSA
| | - Michael Armaneous
- David Geffen School of Medicine at UCLA—Department of Head & Neck SurgeryLos AngelesCaliforniaUSA
| | | | - Dipti Sajed
- David Geffen School of Medicine at UCLA—Department of Head & Neck SurgeryLos AngelesCaliforniaUSA
| | - Maie St. John
- David Geffen School of Medicine at UCLA—Department of Head & Neck SurgeryLos AngelesCaliforniaUSA
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Rohr E, Laverde-Saad A, Zargham H, Chergui M, Watters K, Balbul A. An unusually indolent well-differentiated Wilson-Jones angiosarcoma: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231212988. [PMID: 38022853 PMCID: PMC10656791 DOI: 10.1177/2050313x231212988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Cutaneous angiosarcomas are rare soft tissue tumours originating from hematogenous vasculature that are aggressive and carry a poor prognosis. We describe the case of a 73-year-old man with a low-grade well-differentiated angiosarcoma. Our case distinguishes itself from those previously reported in the slow progression and important delay to the presentation of 30 months and survival time of 5.5 years. Additionally, its severe clinical appearance (T2 stage) but milder pathological picture (T1 stage) is very uncommon. A repeat biopsy is warranted when results are inconclusive and there is a high clinical suspicion of angiosarcoma.
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Affiliation(s)
- Eliana Rohr
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Hanieh Zargham
- Department of Dermatology and Skin Science, The Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - May Chergui
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Kevin Watters
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Alfred Balbul
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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Kim WJ, Kim HK. Current understanding of angiosarcoma: disease biology and evolving treatment. Arch Craniofac Surg 2023; 24:203-210. [PMID: 37919906 PMCID: PMC10622948 DOI: 10.7181/acfs.2023.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023] Open
Abstract
Angiosarcoma is a very rare soft tissue sarcoma that originates from endothelial cells and typically has a poor prognosis. It is most commonly found in elderly white men and can occur anywhere in the body, particularly in the head, neck, and scalp. Patients who have undergone previous radiation treatment or who have chronic lymphedema also face an elevated risk of this condition. Various genetic changes are suspected to contribute to the development of angiosarcoma, and these changes have been identified as potential targets for treatment. For localized disease, wide surgical resection is often the prudent course of action. A multidisciplinary approach, which may include surgery, radiotherapy, systemic chemotherapy, or immunotherapy, is typically the most effective way to achieve favorable outcomes. In this review, we discuss the general understanding of angiosarcoma and its management, with a particular focus on the current evolving treatments for the disease.
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Affiliation(s)
- Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong, Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
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Yoder AK, Farooqi AS, Wernz C, Subramaniam A, Ravi V, Goepfert R, Sturgis EM, Mitra D, Bishop AJ, Guadagnolo BA. Outcomes after definitive treatment for cutaneous angiosarcomas of the face and scalp: Reevaluating the role of surgery and radiation therapy. Head Neck 2023; 45:1943-1951. [PMID: 37272774 PMCID: PMC11350586 DOI: 10.1002/hed.27418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION We investigated outcomes and prognostic factors for patients treated for cutaneous angiosarcoma (CA). METHODS We conducted a retrospective review of patients treated for CA of the face and scalp from 1962 to 2019. All received definitive treatment with surgery, radiation (RT), or a combination (S-XRT). The Kaplan-Meier method was used to estimate outcomes. Multivariable analyses were conducted using the Cox proportional hazards model. RESULTS For the 143 patients evaluated median follow-up was 33 months. Five-year LC was 51% and worse in patients with tumors >5 cm, multifocal tumors, those treated pre-2000, and with single modality therapy (SMT). These remained associated with worse LC on multivariable analysis. The 5-year disease-specific survival (DSS) for the cohort was 56%. Tumor size >5 cm, non-scalp primary site, treatment pre-2000, and SMT were associated with worse DSS. CONCLUSION Large or multifocal tumors are negative prognostic factors in patients with head and neck CA. S-XRT improved outcomes.
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Affiliation(s)
- Alison K Yoder
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahsan S Farooqi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Cort Wernz
- Baylor College of Medicine, Houston, Texas, USA
| | - Aparna Subramaniam
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Goepfert
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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Guan L, Palmeri M, Groisberg R. Cutaneous angiosarcoma: A review of current evidence for treatment with checkpoint inhibitors. Front Med (Lausanne) 2023; 10:1090168. [PMID: 36993810 PMCID: PMC10040781 DOI: 10.3389/fmed.2023.1090168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
Cutaneous angiosarcoma (cAS) is a rare and aggressive subtype of soft tissue sarcoma with poor prognosis and suboptimal treatment options. Clinical presentation is variable, but cAS often arises from the head and neck. The most widely accepted current approach, surgical excision with adjuvant radiotherapy, is associated with high recurrence rates and can leave patients with profound disfigurement. Chemotherapy and targeted therapy alternatives have had limited success. Thus, there is a significant unmet need to address the absence of durable treatments for advanced and metastatic cAS. Like melanoma and cutaneous squamous cell carcinoma, tumor types with known response to immunotherapy, cAS harbors immune biomarkers, such as tumor mutational burden high (TMB-H), PD-L1 positivity, ultraviolet signature expression, and tertiary lymphoid structures. While data on the use and efficacy of immunotherapy in cAS is limited, the biomarkers suggest a promising advancement in future treatment options. This review aims to summarize and discuss current data from case reports, case series, retrospective studies and clinical trials regarding immunotherapy treatment and outcomes for cAS.
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Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4827. [PMID: 36875926 PMCID: PMC9984161 DOI: 10.1097/gox.0000000000004827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/05/2023] [Indexed: 03/06/2023]
Abstract
Cutaneous angiosarcomas are rare, aggressive tumors with high recurrence and poor prognosis. We share our experiences with the challenging surgical management of these lesions, focusing on both ablative and reconstructive outcomes. Methods Retrospective cross-sectional chart review was conducted of patients diagnosed with scalp cutaneous angiosarcoma between 2005 and 2021. Resectability, defect reconstruction, and survival outcomes were analyzed. Results Thirty patients were included, 27 (90%) men and three (10%) women, with a mean age at diagnosis of 71.77 ± 7.3 years, and mean follow-up of 429.43 ± 305.6 days. Only 12 patients completed their regular follow-up, while the remaining patients died. There was a median survival of 443.50 days (range, 42-1283) and median time to recurrence of 21 days (range, 30-1690). Multimodal therapy compared with surgery alone had a significantly better overall median survival (468 days versus 71 days; P = 0.021). Defect coverage was obtained in 24 cases (75%) through an anterolateral thigh flap, two patients (6%) with a local transposition flap, and one patient (3%) with a transverse rectus abdominis myocutaneous flap. The remaining three patients received a skin graft. All of the flaps survived, with one requiring a vein graft for venous congestion. Conclusions Timely multimodal therapy with a histologically safe margin, combined with adjuvant therapy, improves survival and delays recurrence and metastasis, in cutaneous angiosarcoma patients. An anterolateral thigh flap facilitates the coverage of wide defects. Further investigations of advanced treatment modalities such as immunotherapy and/or gene therapy are required to deal with this highly aggressive tumor.
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Ramakrishnan N, Mokhtari R, Charville GW, Bui N, Ganjoo K. Cutaneous Angiosarcoma of the Head and Neck-A Retrospective Analysis of 47 Patients. Cancers (Basel) 2022; 14:cancers14153841. [PMID: 35954504 PMCID: PMC9367417 DOI: 10.3390/cancers14153841] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cutaneous angiosarcoma (CAS) is a rare sarcoma with dismal prognosis. To better characterize this disease and elucidate potential treatments that improve overall survival (OS), we conducted a retrospective study exploring clinical characteristics and treatment outcomes of 47 patients with CAS of the head and neck treated at a tertiary academic center. We found that CAS continues to have a poor prognosis with high rates of recurrence even with current treatment modalities. Surgery was highly effective in improving OS in patients with disease that could be resected with low morbidity. Chemotherapy, radiotherapy (RT), and immunotherapy did not significantly improve OS. Our findings shed light on the current landscape of clinical characteristics and treatment of CAS and could prompt further research exploring new treatment options and role of immunotherapy in the management of this difficult disease. Abstract Cutaneous angiosarcoma (CAS) is a rare and aggressive malignant tumor with blood vessel or lymphatic-type endothelial differentiation. It has a poor prognosis with lack of standardized treatment options. This study retrospectively evaluated the clinical characteristics and treatment outcomes of 47 patients with CAS of the head and neck treated at an academic sarcoma center. Patient data were collected from the electronic medical records. 62% of patients were male with the scalp being the most commonly affected area (64%). The majority of patients presented with localized disease (53%). Median overall survival (OS) was 3.4 years with an OS of 36% at 5 years. There was a statistically significant increase in OS for patients who underwent surgery compared to those who did not (5.4 vs. 2.8 years). In contrast, radiotherapy (RT) or chemotherapy did not significantly increase OS. 45% of patients had recurrence of disease during their treatment course with a median time to recurrence of 22.8 months. There was not a significant difference in OS for patients who underwent immunotherapy compared to those who underwent chemotherapy, although only a few patients received immunotherapy. We found that surgery was an effective treatment modality in patients with easily resectable disease, while RT, chemotherapy, and immunotherapy did not significantly improve OS.
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Affiliation(s)
- Neeraj Ramakrishnan
- Department of Medicine, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA
- Correspondence: ; Tel.: +1-707-569-4700
| | - Ryan Mokhtari
- Department of Medicine/Oncology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Gregory W. Charville
- Department of Pathology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Nam Bui
- Department of Medicine/Oncology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Kristen Ganjoo
- Department of Medicine/Oncology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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15
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Conforti F, Gronchi A, Penel N, Jones RL, Broto JM, Sala I, Bagnardi V, Napolitano A, Pala L, Pennacchioli E, Catania C, Queirolo P, Grigani G, Merlini A, Stacchiotti S, Comandone A, Vincenzi B, Quagliuolo V, Bertuzzi A, Boglione A, Palassini E, Baldi GG, Blay JY, Ryckewaert T, Toulmonde M, Italiano A, Le Cesne A, Ray-Coquard I, Cruz J, Hernández-León CN, Trufero JM, da Silva Moura D, Muñiz NH, De Pas T. Chemotherapy in patients with localized angiosarcoma of any site: A retrospective european study. Eur J Cancer 2022; 171:183-192. [PMID: 35728378 DOI: 10.1016/j.ejca.2022.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND We retrospectively investigated the role of (neo)adjuvant chemotherapy in patients with primary, localized angiosarcoma. METHODS We selected all patients with primary, localized angiosarcoma, who had received radical surgery between January 2005 and December 2019 at 33 European sarcoma reference centers. The primary objective was to compare the outcome of patients who received (neo)adjuvant chemotherapy versus those who did not, in terms of overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS). To reduce the risk of confounding due to imbalance, a propensity-score matching(PSM) was performed. Finally, subgroups analysis was performed according to tumor site, tumor size (< 50 mm or ≥ 50 mm) and patients predicted 10-years OS according to the nomogram sarculator (two different cutoff-values were applied: ≤ 33% or > 33% and < 60% or ≥ 60%). RESULTS 362 patients were analyzed: 149 (41.2%; treated group) received (neo) adjuvant chemotherapy and 213 (58.6%; control group) did not. The median follow-up for the OS endpoint was 5.1 years (95% CI: 4.0-5.5). The OS-HR was 0.58 (95%CI: 0.40-0.83; p-value = 0.003) in the univariate analysis and 0.74 (95% CI: 0.38-1.43; p = 0.367) in the PSM analysis. The DFS-HR was 0.75 (95% CI: 0.57-0.98; p-value = 0.036) in the univariate analysis, and 0.91 (95% CI:0.56-1.48; p-value = 0.7) in the PSM analysis. The DMFS-HR was 0.75 (95% CI: 0.55-1.02; p-value = 0.065) in univariate analysis and 0.92 (95% CI: 0.53-1.61; p-value = 0.769) in the PSM analysis. Subgroup analysis revealed no heterogeneity of results in strata of tumor site. On the contrary, there was a trend for heterogeneity according to tumor size and patient's risk of death. For all the endpoints analyzed, patients with tumors smaller than 50 mm or at lower risk of death seem to have no benefit from chemotherapy, while patients with larger tumors or at higher risk of death at 10 years seem to derive substantial benefit. CONCLUSION This large, retrospective study suggests that patients affected by > 50 mm and/or high-risk primary, localized angiosarcoma could benefit from (neo)adjuvant chemotherapy.
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Affiliation(s)
- Fabio Conforti
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan, Italy.
| | | | - Nicholas Penel
- Lille University and Centre Oscar Lambret, Lille, France
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Javier M Broto
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), Madrid, Spain; Medical Oncology Department, Hospital Fundación Jimenez Diaz University Hospital, Madrid, Spain; General de Villalba University Hospital, Madrid, 28400, Spain; Autonomous University of Madrid, Madrid, Spain
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Andrea Napolitano
- Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Laura Pala
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Paola Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Giovanni Grigani
- Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Turin, Italy
| | - Alessandra Merlini
- Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Turin, Italy; Department of Oncology, University of Turin, Turin, Italy
| | | | | | - Bruno Vincenzi
- Medical Oncology Department, University Campus Bio-Medico, 00128 Rome, Italy
| | | | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | - Elena Palassini
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giacomo G Baldi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Jean-Yves Blay
- Centre Léon Bérard & University Cl. Bernard Lyon I, EURACAN, LYRICAN, Lyon, France
| | | | - Maud Toulmonde
- Department of Medicine, Institut Bergonié, Bordeaux, Nouvelle-Aquitaine
| | - Antoine Italiano
- Department of Medicine, Institut Bergonié, Bordeaux, Nouvelle-Aquitaine
| | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Isabelle Ray-Coquard
- Centre Leon Bérard, Hesper Lab, EA 7425, Université Claude Bernard Lyon Est, Lyon, France
| | - Josefina Cruz
- Oncology Department, University Hospital of Canary Islands, Canary Islands, Spain
| | | | - Javier M Trufero
- Oncology Department, University Hospital Miguel Servet, Zaragoza, Spain
| | - David da Silva Moura
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), Madrid, Spain; Autonomous University of Madrid, Madrid, Spain
| | - Nadia H Muñiz
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD), Madrid, Spain; Medical Oncology Department, Hospital Fundación Jimenez Diaz University Hospital, Madrid, Spain; General de Villalba University Hospital, Madrid, 28400, Spain; Autonomous University of Madrid, Madrid, Spain
| | - Tommaso De Pas
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan, Italy
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16
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Messias H, Martins M, Zagalo C, Gomes P. Multifocal cutaneous angiosarcoma of the scalp—A challenging reconstructive case managed with skin substitutes. Cancer Rep (Hoboken) 2022; 5:e1659. [PMID: 35819124 PMCID: PMC9575495 DOI: 10.1002/cnr2.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cutaneous angiosarcoma (AS) of the head and neck is a rare highly aggressive tumor, often associated with difficult local control of the disease and poor prognosis. This article describes a case of multifocal cutaneous AS of the scalp, mainly addressing its difficult surgical management and challenging reconstruction and concludes with a review of the literature. Methods A 70‐year‐old Caucasian male was referred to our hospital with a growing scalp lesion initially suspected to be benign, but later diagnosed with AS. Results The patient had tumor recurrence and a difficult reconstruction for which dermal substitutes proved very useful. Conclusion AS can mimic a benign lesion in its early stages. Skin substitutes, namely dermal templates, can be useful to meet the complex needs of reconstruction and oncological surveillance of patients with AS.
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Affiliation(s)
- Henrique Messias
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
- Division of Health Sciences University of Edinburgh Edinburgh United Kingdom
| | - Mariluz Martins
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
| | - Carlos Zagalo
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
| | - Pedro Gomes
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
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17
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Subramaniam A, Giani C, Napolitano A, Ravi V, Frezza AM, Jones RL. Management of Vascular Sarcoma. Surg Oncol Clin N Am 2022; 31:485-510. [PMID: 35715146 DOI: 10.1016/j.soc.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular sarcomas encompass 3 well-defined sarcoma types: hemangioendothelioma, Kaposi sarcoma, and angiosarcoma. These distinct types are exceedingly rare and very different in terms of clinical behavior, biological features, and treatment approach. Because of this rarity and heterogeneity, it is crucial that vascular sarcomas are treated in sarcoma reference centers or networks, in order to ensure optimal management. The diversity of vascular sarcomas also needs to be taken into account in the design of clinical trials, in order to produce meaningful results that can be consistently translated into everyday clinical practice.
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Affiliation(s)
- Aparna Subramaniam
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 0450, FC12.3044, Houston, TX 77030, USA
| | - Claudia Giani
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 0450, FC12.3044, Houston, TX 77030, USA.
| | - Anna Maria Frezza
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
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18
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Goerdt LV, Schneider SW, Booken N. Kutane Angiosarkome: molekulare Pathogenese und neue therapeutische Ansätze. J Dtsch Dermatol Ges 2022; 20:429-444. [PMID: 35446507 DOI: 10.1111/ddg.14694_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/16/2021] [Indexed: 12/27/2022]
Abstract
Das kutane Angiosarkom (CAS) ist ein hochaggressiver maligner Tumor mit schlechter Prognose. Das primäre, spontane CAS (pCAS) und das sekundäre, mit einer Bestrahlung oder einem Lymphödem assoziierte CAS (sCAS) unterscheiden sich klinisch sowie molekular. Die Amplifikation/Überexpression von Myc ist ein charakteristisches, wenn auch nicht ausschließliches Merkmal von sCAS, während der Verlust von TP53 selektiv bei pCAS vorkommt. Detaillierte molekulare Analysen mit modernen Multi-Omics-Ansätzen haben gezeigt, dass sowohl pCAS als auch sCAS eine erhebliche molekulare Heterogenität aufweisen. Die betroffenen Gene und ihre molekularen Regulatoren sind mögliche therapeutische Zielstrukturen. Darüber hinaus kann das pCAS in Cluster mit hoher Mutationsrate und/oder ausgeprägten Entzündungssignaturen eingeteilt werden, die als Grundlage für die künftige Stratifizierung von pCAS-Patienten in immuntherapeutischen klinischen Studien dienen können. Während die Aufklärung der der Erkrankung zugrunde liegenden molekularen Veränderungen zügig voranschreitet, verläuft die Entwicklung daraus abgeleiteter neuer Therapien für das CAS jedoch bisher eher langsam. Dennoch wurden einige über die Standardtherapien wie Operation und Radiochemotherapie hinausgehende klinische Studien zu neuen Behandlungsmöglichkeiten initiiert. Dazu gehören zielgerichtete Therapien gegen VEGF und VEGFR1-3 wie Bevacizumab und Pazopanib, sowie β-Adrenozeptorenblocker wie Propranolol. Derzeit werden auch Immuntherapien entwickelt, unter anderem unter Verwendung der Immuncheckpoint-Inhibitoren Pembrolizumab und Nivolumab sowie des Anti-RANKL-Antikörper Denosumab.
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Affiliation(s)
- Lea V Goerdt
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg.,Asklepios Campus Hamburg, medizinische Fakultät, Semmelweis Universität Budapest, Hamburg
| | - Stefan W Schneider
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Nina Booken
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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19
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Yan Q, Fernandez RA, Elmi M, Gelfond J, Davies MG. Outcomes of Interventions for Angiosarcoma. Front Surg 2022; 9:819099. [PMID: 35478727 PMCID: PMC9035688 DOI: 10.3389/fsurg.2022.819099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Angiosarcoma is a rare malignant vascular tumor, and the management and outcome of this disease are not well-described. The aim of this study was to report the incidence, patient demographics, and outcomes of angiosarcoma based on national data. Methods Data on patients with angiosarcoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Inverse probability treatment weights (IPTW) were used to assess the survival benefit of operation with additional chemo or radiation therapy compared to operation alone. These variables were further compared against patients who did not receive an operation despite being initially offered one. Cox regression was used to assess survival. Statistical analyses were performed on RStudio. Results For this study, 5,135 patients (46% men; median age 69, range 0–102) with angiosarcoma were identified in the SEER database between 1975 and 2016. The age-adjusted incidence rate was 1–4%. Patients were mostly non-Hispanic Caucasian (75.4%). The average tumor size was 4.7 cm, range (.1–98.9). Tumor grades were high at presentation (Grade III 17.2, Grade IV 19, and unknown 50.6%), but half were considered localized tumors. Most patients underwent an operation (66.1%). In 5.6% of patients, the operation was recommended but not performed. The overall 5-year survival was 26.7% (95% CI 25.4–28.1%). IPTW with adjusted Cox proportional hazard model demonstrated worse survival, showing that operation compared to no operation and operation with chemo/radiation compared to operation alone had worse survival between months 0 and 25 but had improved survival after month 25. Conclusions The incidence of angiosarcoma is low and long-term survival is poor. Multimodal therapy in the form of neoadjuvant or adjuvant chemo/radiation therapy offers significant long-term survival benefits over operation alone.
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Affiliation(s)
- Qi Yan
- Department of Surgery, Long School of Medicine University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Roman A. Fernandez
- Department of Population Health Sciences, Long School of Medicine University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Maryam Elmi
- Department of Surgery, Long School of Medicine University of Texas Health at San Antonio, San Antonio, TX, United States
- MD Anderson Cancer Center, Long School of Medicine University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Jonathan Gelfond
- Department of Population Health Sciences, Long School of Medicine University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Mark G. Davies
- Division of Vascular and Endovascular Surgery, Long School of Medicine University of Texas Health at San Antonio, San Antonio, TX, United States
- South Texas Center for Vascular Care, South Texas Medical Center, San Antonio, TX, United States
- *Correspondence: Mark G. Davies
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20
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Goerdt LV, Schneider SW, Booken N. Cutaneous Angiosarcomas: Molecular Pathogenesis Guides Novel Therapeutic Approaches. J Dtsch Dermatol Ges 2022; 20:429-443. [PMID: 35218306 DOI: 10.1111/ddg.14694] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022]
Abstract
Cutaneous angiosarcoma (CAS) is a highly aggressive cancer with a poor prognosis. Primary, spontaneous CAS (pCAS) and secondary, post-irradiation- or lymphedema-associated CAS (sCAS) are clinically, but also molecularly distinct. Myc amplification/overexpression is a characteristic, although not exclusive feature of sCAS, while loss of TP53 selectively occurs in pCAS. Detailed molecular analyses with modern multi-omics approaches have revealed that both pCAS and sCAS exhibit considerable molecular heterogeneity. Affected genes and their molecular regulators including a plethora of microRNAs may serve as future drug targets. Furthermore, pCAS could be subdivided into clusters with high tumor mutational burden and/or high tumor inflammation signatures providing a rationale for the stratification of pCAS patients in future immunotherapeutic clinical studies. Development of novel treatment regimens guided by these molecular alterations, however, cannot fully keep up with the pace of their discovery due to the low incidence of the disease. Nevertheless, beyond conventional surgery and chemoradiotherapy, clinical trials investigating novel treatment options have been initiated including targeted therapies against VEGF and VEGFR1-3 such as bevacizumab and pazopanib, and β-adrenoreceptor blockers such as propranolol. Finally, immunotherapies are being developed including immune checkpoint inhibitors pembrolizumab and nivolumab as well as anti-RANKL antibody denosumab.
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Affiliation(s)
- Lea V Goerdt
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Asklepios Campus Hamburg, Medical Faculty, Semmelweis University Budapest, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nina Booken
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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21
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Abstract
OPINION STATEMENT Cutaneous angiosarcoma is a rare and invasive malignant tumor. For localized cAS patients, wide-margin excision was recommended. Due to the latent local invasion characteristic of cAS, we suggest preoperative and postoperative radiotherapy to nearly all patients. Recently, there is growing interest in using neoadjuvant chemotherapy and/or radiotherapy as part of a combination therapy regimen, which may allow some patients to undergo potentially less disabling surgery. For metastatic cAS patients with unresectable tumors and who refuse surgery, radical radiotherapy or chemoradiotherapy may be an option. Paclitaxel was recognized as the first-line treatment. For tumors resistant to taxanes, emerging medications such as targeted agents and immunotherapy are also under investigation.
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22
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Liu YY, Xu BS, Pan QZ, Weng DS, Zhang X, Peng RQ. New nomograms to predict overall and cancer-specific survival of angiosarcoma. Cancer Med 2021; 11:74-85. [PMID: 34786885 PMCID: PMC8704180 DOI: 10.1002/cam4.4425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/25/2022] Open
Abstract
Objective This study was designed to establish and validate promising and reliable nomograms for predicting the survival of angiosarcoma (AS) patients. Methods The Surveillance, Epidemiology, and End Results database was queried to collect the clinical information of 785 AS patients between 2004 and 2015. Data were split into a training cohort (n = 549) and a validation cohort (n = 236) without any preference. Univariate Cox and multivariate Cox regression analyses were performed to analyze the clinical parameters. Independent prognostic factors were then identified. Two nomograms were constructed to predict overall survival (OS) and cancer‐specific survival (CSS) at 3 and 5 years. Finally, the models were evaluated using concordance indices (C‐indices), calibration plots, and decision curve analysis (DCA). Results Based on the inclusion and exclusion criteria, 785 individuals were included in this analysis. Univariate and multivariate Cox regression analyses revealed that age, tumor size, and stage were prognostic factors independently associated with the OS of AS. Tumor site, tumor size, and stage were associated with the CSS of AS. Based on the statistical results and clinical significance of variables, nomograms were built. The nomograms for OS and CSS had C‐indices of 0.666 and 0.654, respectively. The calibration curves showed good agreement between the predictive values and the actual values. DCA also indicated that the nomograms were clinically useful. Conclusion We established nomograms with good predictive ability that could provide clinicians with better predictions about the clinical outcomes of AS patients.
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Affiliation(s)
- Yuan-Yuan Liu
- Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Bu-Shu Xu
- Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiu-Zhong Pan
- Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - De-Sheng Weng
- Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xing Zhang
- Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Rui-Qing Peng
- Melanoma and Sarcoma Medical Oncology Unit, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Towards precision oncology in angiosarcomas using next generation "omic" technologies. Oncotarget 2021; 12:1953-1955. [PMID: 34548911 PMCID: PMC8448512 DOI: 10.18632/oncotarget.27996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Angiosarcomas are a group of aggressive tumors of vascular origin. Although thought to be a rare cancer constituting just 1–2% of all soft tissue sarcomas, recent observations suggest that angiosarcomas are more common amongst Asian populations as compared to the West, suggesting the possibility of distinct genetic or environmental triggers influencing its pathogenesis. Advances in genomic sequencing efforts have led to the discovery of ultraviolet mutation signatures and high tumor mutation burden as common features of angiosarcoma of the head and neck. In addition, multi-omic analyses integrated with clinical data identified 3 subtypes characterized by distinctive etiological and biological phenotypes, with potential implications on precision therapy. The systemic and local immune milieu, as well as the presence of “giant” tumor cells, was also recently demonstrated to influence clinical behavior and patient outcomes, further highlighting complexities of this disease. Improvements in next generation “omic”-based technologies are expected to improve our understanding of angiosarcoma and guide the development of precision oncology in this rare cancer.
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Albrecht M, Hadaschik E, Zimmer L, Livingstone E, Hamacher R, Bauer S, Schadendorf D, Ugurel S. [Cutaneous angiosarcoma clinically presenting as Quincke's edema]. DER HAUTARZT 2021; 72:801-804. [PMID: 33439269 PMCID: PMC8416850 DOI: 10.1007/s00105-020-04748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
We report a case of a 75-year-old man with facial edema that also affected the periorbital area who was admitted to the hospital with the suspected diagnosis of Quincke's edema. The diagnosis of cutaneous angiosarcoma was made by microscopic examination and immunohistochemical staining. Chemotherapy was initially initiated because the angiosarcoma was unresectable and the radiation situation was difficult. Therapy has to be switched to second and third line therapy due to disease progression. The case illustrates the complexity of diagnosis and therapy in patients with cutaneous angiosarcoma.
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Affiliation(s)
- M Albrecht
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - E Hadaschik
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - L Zimmer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - E Livingstone
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - R Hamacher
- Sarkomzentrum, Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - S Bauer
- Sarkomzentrum, Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - D Schadendorf
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - S Ugurel
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
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Mao J, Hu J, Chen Y, Li Y, Run X. Development and validation of a prognostic nomogram model in primary cutaneous and subcutaneous soft tissue angiosarcoma. J DERMATOL TREAT 2021; 33:2466-2474. [PMID: 34429003 DOI: 10.1080/09546634.2021.1968333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The current study aimed to investigate the prognosis and treatment of primary cutaneous angiosarcoma (PCA) and primary subcutaneous angiosarcoma (PSCA), and tried to develop a prognostic nomogram model of them. METHODS A total of 1763 cases retrieved from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. Survival analyses were performed to explore the prognosis of patients and the effects of different treatment methods. All data were randomly allocated into a training set and a testing set to develop and validate the nomogram model. RESULTS The findings showed that age, sex, grade, tumor size, multiple primary malignant tumors, stage, primary site surgery (PSS), radiotherapy (RT), and chemotherapy (CT) were correlated with prognosis (p < .05). The nomogram achieved good accuracy in predicting the prognosis. PSS + RT + CT showed the best prognosis for patients in stages I, II, and III (p < .05). CONCLUSION PCA and PSCA are rare with poor prognoses. Patients undergoing PSS may not gain survival benefits from combining with RT or (and) CT, whereas PSS + RT + CT should be actively performed in earlier stages to improve the prognosis of patients. The nomogram model can be used to predict the overall survival rate and guide better treatment.
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Affiliation(s)
- Jinqian Mao
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, WuHan, China
| | - Jin Hu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, WuHan, China
| | - Yunfei Chen
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, WuHan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, WuHan, China
| | - Xiaoqin Run
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, WuHan, China
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Ren B, Wang W, Tan J, Yuan B, Chen G, Mo X, Fan J, Yang B, Huang X. Efficacy of Anlotinib for the Treatment of Angiosarcoma of the Face and Neck: A Case Report. Front Oncol 2021; 11:596732. [PMID: 34262854 PMCID: PMC8273654 DOI: 10.3389/fonc.2021.596732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Angiosarcoma of the face and neck is a rare soft tissue sarcoma with a high degree of malignancy. The current treatment methods mainly rely on a combination of surgery and radiotherapy and/or chemotherapy. However, the options for drug treatment are very limited and surgery can be difficult to carry out due to the location of the tumor, so the efficacy of first-line drugs needs to be constantly explored. A case of angiosarcoma of the head and face diagnosed by biopsy is reported here. The patient received an oral anlotinib hydrochloride capsule once a day (12 mg on days 1 - 14/1 week off for a 21-day cycle) due to the difficulty of surgery. Until now (April, 2020), after 10 months of treatment, the patient's scalp and facial lesions have gradually reduced and the partial response and progression-free survival of this patient were good, with moderate or tolerable adverse events. This approach provides a new approach for the clinical treatment of malignant angiosarcoma of the face and neck with anlotinib as first-line therapy.
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Affiliation(s)
- Biyong Ren
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Wei Wang
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Jing Tan
- Department of Gastrointestinal, Thyroid and Vascular Surgery, Chongqing University, Three Gorges Hospital, Chongqing, China
| | - Bo Yuan
- Department of Oncology, Yunyang County People's Hospital, Chongqing, China
| | - Guilan Chen
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Xiaofei Mo
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Jieqiong Fan
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Bo Yang
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Xiaoping Huang
- Department of Medical Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
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Periasamy K, Das N, Khosla D, Kapoor R. Recurrent angiosarcoma of scalp with opsoclonus myoclonus syndrome: role of salvage treatment. BMJ Case Rep 2021; 14:e241824. [PMID: 34172478 PMCID: PMC8238976 DOI: 10.1136/bcr-2021-241824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
Cutaneous angiosarcoma is a type of rare and locally aggressive malignancy requiring individualised treatment owing to paucity of randomised trials. We present the case of a middle-aged cancer survivor with locally advanced angiosarcoma of scalp managed with surgery, radiotherapy, chemotherapy and targeted therapy over a course of 6 years for two recurrences. The first recurrence was preceded by opsoclonus myoclonus syndrome, a type of paraneoplastic neurological syndrome (PNS), rarely reported in sarcomas. The second recurrence had a rapid clinical course, which led to a therapeutic dilemma of best supportive care versus active management. A trial of weekly paclitaxel was started that was continued for a total of 12 cycles with good objective clinical response. Presently, he is tolerating maintenance pazopanib well and is symptom free for 6 months. In cutaneous angiosarcoma patients, PNS may be a harbinger of recurrence and aggressive, multimodality treatment helps prolong survival.
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Affiliation(s)
- Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Das
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Director, Homi Bhabha Cancer Hospital, Sangrur, India
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Clinical outcomes following high-dose-rate surface applicator brachytherapy for angiosarcoma of scalp and face. J Contemp Brachytherapy 2021; 13:172-178. [PMID: 33897791 PMCID: PMC8060956 DOI: 10.5114/jcb.2021.105285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Angiosarcoma is a sub-type of soft tissue sarcoma, often presenting as a multifocal or diffuse disease process with poor prognosis. This study presents outcomes of a single institution cohort of patients with angiosarcoma of the scalp and face following treatment with multimodality therapy, including high-dose-rate surface applicator (HDR-SA) brachytherapy, and represents the largest cohort utilizing this therapeutic approach. Material and methods Twenty patients with primary or recurrent angiosarcoma of the face or scalp were treated with HDR-SA brachytherapy between 2003-2018, with clinical characteristics and outcomes collected from medical records and used to identify prognostic features. Results Median follow-up was 45 months. Patients treated with HDR-SA brachytherapy had a 4-year local control rate of 63%, a 4-year progression-free survival (PFS) rate of 20%, and a 4-year overall survival rate of 54%. Disease features associated with worse loco-regional control (LRC) included location on the scalp (vs. face, p = 0.04) and tumor size ≥ 5 cm (p = 0.0099). Outcomes after HDR-SA brachytherapy for salvage therapy vs. HDR-SA brachytherapy as a component of an initial treatment approach were also significantly different, with worse LRC (p = 0.0084) and worse overall survival (OS) (p = 0.0019) in a setting of salvage therapy. Conclusions Local control rates following HDR-SA brachytherapy for scalp or face angiosarcoma are moderate and similar to what is described in the literature using a variety of local control treatment modalities. Smaller tumors and those involving the face rather than scalp had better outcomes. PFS rates were poor and there is a pressing need for treatment intensification and novel therapeutic options.
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Abstract
Epithelioid angiosarcoma is a rare and very aggressive malignant tumor with high rates of metastasis and recurrence that can present in any part of the body, with the head and neck being the most common regions. Wide-margin surgical resection is the treatment of choice following radiotherapy due to the high rate of recurrence. We present a case of an elderly patient who developed angiosarcoma causing spinal cord compression at the level of C7 vertebrae. We discuss the diagnosis, treatment, histopathology, and outcome.
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Affiliation(s)
- Luis F Lemus
- Department of Surgery, Universidad Dr. José Matías Delgado, San Salvador, SLV
| | - Mario H Minervini
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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30
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Bi S, Chen S, Wu B, Cen Y, Chen J. The Effectiveness of Different Treatment Modalities of Cutaneous Angiosarcoma: Results From Meta-Analysis and Observational Data From SEER Database. Front Oncol 2021; 11:627113. [PMID: 33718199 PMCID: PMC7947850 DOI: 10.3389/fonc.2021.627113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/22/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Cutaneous angiosarcoma (cAS) is an aggressive vascular tumor that originates from vascular or lymphatic epithelial cells. To date, the cAS literature has been limited in a small number with single-center experiences or reports due to its rarity and the optimal treatment strategy is still in dispute. This study aimed to conduct a systematic review and compare the effect of available treatments retrieved from observational studies and Surveillance, Epidemiology, and End Results (SEER) program. Methods The authors performed a systematic review in the PubMed, Embase and MEDLINE database identifying the researches assessing the treatment for cAS patients. Clinical and treatment information of patients who had been diagnosed with a primary cAS were also obtained from the SEER program. Results Thirty-two studies were eligible but only 5 of which with 276 patients were included in meta-analysis since the unclear or unavailable information. The risk ratio of 5-year death for surgery, surgery with radiotherapy and surgery with chemotherapy were 0.84, 0.96, and 0.69. Meanwhile, in SEER database, there are 291 metastatic and 437 localized patients with cAS. The localized patients receiving surgery showed a significantly worse overall survival result when compared with the surgery combined with RT: hazard ratio: 1.6, 95% confidential interval: 1.05, 2.42, P = 0.03. Conclusion In conclusion, our study provided a detailed picture of the effectiveness of present treatments for localized and metastatic cAS patients. The CT could be inappropriate in localized patients. For metastatic patients, the surgery combined RT was recommended compared with surgery alone since its enhanced OS prognosis. Yet, more novel-designed clinical trials with specific targeted populations and rigorous conducting are needed for a solid conclusion on which would be a better treatment strategy.
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Affiliation(s)
- Siwei Bi
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shanshan Chen
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Beiyi Wu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ying Cen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junjie Chen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Abstract
Cutaneous sarcomas represent a rare group of tumors presenting in the head and neck. In this article, we discuss specific sarcoma tumor types and their presentation, pathogenesis, histologic findings, and management recommendations. Tumors to be reviewed include dermatofibrosarcoma protuberans, atypical fibroxanthoma, pleomorphic dermal sarcoma, cutaneous leiomyosarcoma, and angiosarcoma.
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Affiliation(s)
- Brittny N Tillman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical School, 2001 Inwood Road, Dallas, TX 75390-8868, USA.
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Fox Chase Cancer Center, 3440 North Broad Street, Philadelphia, PA 19140, USA
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32
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Dev T, Bakhshi S, Naranje P, Khandpur S. Blood-filled masses on scalp in a middle-aged woman. Indian J Dermatol Venereol Leprol 2021; 87:82-85. [PMID: 33580927 DOI: 10.25259/ijdvl_400_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Tanvi Dev
- Department of Dermatology and Venereology Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | - Priyanka Naranje
- Department of Radiology, All India Institute of Medical Sciences New Delhi, India
| | - Sujay Khandpur
- Department of Dermatology and Venereology Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
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Muramatsu N, Ito S, Hanmura M, Nishimura T. Development of a transparent and flexible patient-specific bolus for total scalp irradiation. Radiol Phys Technol 2021; 14:82-92. [PMID: 33484400 DOI: 10.1007/s12194-021-00606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
A commercially available flat bolus (commercial bolus) would not fully fit the irregular surfaces of the scalp. We developed a transparent and flexible material with good fitting properties, analyzed its physical characteristics, and evaluated the clinical feasibility of the bolus fabricated using a three-dimensional (3D) printer (3D bolus). To evaluate the physical characteristics of the new material, treatment plans with virtual, 3D, and commercial boluses were created for water-equivalent phantoms using a radiation treatment planning system (RTPS). Using a head phantom and the dose volume histogram calculated with RTPS, dose distributions for total scalp irradiation were compared between the three treatment plans. To evaluate the clinical feasibility, the fitness and reproducibility of the 3D bolus were compared with the head phantom and clinical cases using dice similarity coefficient (DSC) measurements. A good agreement was observed between the percentage depth dose (PDD) curves for the virtual, 3D, and commercial boluses. The homogeneity indexes of the planning target volume (PTV) for the 3D and commercial boluses were 0.083 and 0.153, respectively, proving that the former achieved a better dose uniformity of PTV than the latter. Good fitness and reproducibility with the 3D bolus were observed in both the head phantom and two clinical cases, with mean DSC values of 0.854, 0.829, and 0.843, respectively. These results successfully demonstrated and verified the utility of the 3D bolus for total scalp irradiation.
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Affiliation(s)
- Noriaki Muramatsu
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Satoshi Ito
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masahiro Hanmura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tetsuo Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Lee KT, Moon J, Jeong HS, Lim HS, Lim SY. Benefits of the Multidisciplinary Approach After Curative Surgery for the Treatment of Scalp Angiosarcoma. Ann Plast Surg 2021; 86:39-45. [PMID: 32541541 DOI: 10.1097/sap.0000000000002462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with scalp angiosarcoma still present with a dismal prognosis, indicating the need for a multidisciplinary approach. The present study aimed to investigate the treatment outcomes of scalp angiosarcoma with a focus on the effect of radiotherapy and chemotherapy, performed in either an adjuvant or palliative setting, after curative surgical treatment. METHODS Patients with scalp angiosarcoma without evidence of systemic metastasis who were treated with curative ablative surgery between 2008 and 2018 were assessed. Oncologic outcomes, including recurrence-free survival (RFS) and overall survival (OS), were evaluated. RESULTS A total of 23 patients were analyzed. All patients underwent radical resection, most of whom (82.6%) achieved R0 resection. Adjuvant radiotherapy and chemotherapy (all taxane-based) were delivered for 11 and 3 patients, respectively. Recurrence developed in 17 (73.9%) of 23 patients during a mean follow-up period of 18.4 months. The overall 2-year RFS and OS were 15.5% and 44.4%, respectively. Multivariate analysis showed that adjuvant radiotherapy and chemotherapy were associated with a significantly low risk of recurrence. In 17 patients with recurrence, those receiving palliative radiotherapy or chemotherapy had significantly higher OS than those not receiving any treatments. Compared with patients treated during the first half of the study period, those treated during the latter part, who received adjuvant and palliative radiotherapy or chemotherapy more frequently, had significantly favorable OS, with a 2-year OS of 77.8%. CONCLUSIONS A multidisciplinary approach using radiotherapy and/or chemotherapy combined with curative resection might be associated with better oncologic outcomes in patients with scalp angiosarcoma.
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Affiliation(s)
| | | | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Ha Seong Lim
- Areumdaunnara Dermatology Clinic, Sungnam-city, Kyunggido, South Korea
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Tecce MG, Othman S, Mauch JT, Nathan S, Tilahun E, Broach RB, Azoury SC, Kovach SJ. Complex oncologic resection and reconstruction of the scalp: Predictors of morbidity and mortality. Arch Craniofac Surg 2020; 21:229-236. [PMID: 32867412 PMCID: PMC7463124 DOI: 10.7181/acfs.2020.00206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Oncologic resection of the scalp confers several obstacles to the reconstructive surgeon dependent upon patient-specific and wound-specific factors. We aim to describe our experiences with various reconstructive methods, and delineate risk factors for coverage failure and complications in the setting of scalp reconstruction. METHODS A retrospective chart review was conducted, examining patients who underwent resection of fungating scalp tumors with subsequent soft-tissue reconstruction from 2003 to 2019. Patient demographics, wound and oncologic characteristics, treatment modalities, and outcomes were recorded and analyzed. RESULTS A total of 189 patients were appropriate for inclusion, undergoing a range of reconstructive methods from skin grafting to free flaps. Thirty-three patients (17.5%) underwent preoperative radiation. In all, 48 patients (25.4%) suffered wound site complications, 25 (13.2%) underwent reoperation, and 47 (24.9%) suffered from mortality. Preoperative radiation therapy was an independent risk factor for wound complications (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.1-7.3; p = 0.028) and reoperations (OR, 4.45; 95% CI, 1.5-13.2; p = 0.007). Similarly, the presence of an underlying titanium mesh was an independent predictor of wound complications (OR, 2.49; 95% CI, 1.1-5.6; p= 0.029) and reoperations (OR, 3.40; 95% CI, 1.2-9.7; p= 0.020). Both immunosuppressed status (OR, 2.88; 95% CI, 1.2-7.1; p= 0.021) and preoperative radiation therapy (OR, 3.34; 95% CI, 1.2-9.7; p= 0.022) were risk factors for mortality. CONCLUSION Both preoperative radiation and the presence of underlying titanium mesh are independent risk factors for wound site complications and increased reoperation rates following oncologic resection and reconstruction of the scalp. Additionally, preoperative radiation, along with an immunosuppressed state, may predict patient mortality following scalp resection and reconstruction.
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Affiliation(s)
- Michael G Tecce
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Sammy Othman
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaclyn T Mauch
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Shelby Nathan
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Estifanos Tilahun
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Multidisciplinary Management of Angiosarcoma - A Review. J Surg Res 2020; 257:213-220. [PMID: 32858322 DOI: 10.1016/j.jss.2020.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023]
Abstract
Angiosarcomas (AS) are a diverse group of soft tissue sarcomas, arising from blood and lymphatic vessels. They frequently present in the elderly, and in patients with previous radiation or lymphedema. A wide range of genetic derangements contribute to their development, and AS histology is often high-grade in keeping with aggressive disease biology. The clinical presentation, while often innocuous, is marked by its infiltrative and aggressive nature, with a proclivity for metastatic spread, and outcomes are often poor. Surgery is performed for localized, resectable cases. A multidisciplinary approach, appropriately employing surgery, radiation, chemotherapy, or potentially recently approved immune-oncology agents, can result in positive outcomes.
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Oashi K, Shibata T, Namikawa K, Takahashi A, Yokota K, Nakano E, Teramoto Y, Tsutsumida A, Maeda T, Yamazaki N. A single-arm confirmatory trial of pazopanib in patients with paclitaxel-pretreated primary cutaneous angiosarcoma: Japan Clinical Oncology Group study (JCOG1605, JCOG-PCAS protocol). BMC Cancer 2020; 20:652. [PMID: 32660439 PMCID: PMC7359578 DOI: 10.1186/s12885-020-07136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Paclitaxel is a standard of care for patients with primary cutaneous angiosarcoma of the scalp and face. However, no standard second-line treatment for paclitaxel-resistant patients has ever been established. Since primary cutaneous angiosarcoma expresses a high level of vascular endothelial growth factor receptor, the multitargeted tyrosine kinase inhibitor pazopanib seemed to be the most promising agent, and several retrospective studies have demonstrated its activity against this disease. However, the efficacy and safety of pazopanib in paclitaxel-resistant patients with primary cutaneous angiosarcoma have never been evaluated in a clinical trial. Methods In February 2018 the Dermatologic Oncology Group of Japan Clinical Oncology Group started a single-arm confirmatory trial to evaluate the efficacy and safety of pazopanib as a second-line treatment for patients with primary cutaneous angiosarcoma whose disease was resistant to paclitaxel or who were unable to tolerate paclitaxel (JCOG1605, JCOG-PCAS). Patients with primary cutaneous angiosarcoma not associated with lymphedema or radiation, progressing despite first-line paclitaxel monotherapy are included in the study. No prior systemic chemotherapy other than paclitaxel is permitted. Pazopanib is administered orally at an initial dosage of 800 mg once daily. Dose modifications for adverse events are made according to the dose reduction criteria described in the protocol. Treatment is continued until recurrence, disease progression, unacceptable toxic effects, patient refusal, or death. The primary endpoint is progression-free survival, secondary endpoints include overall survival, response rate, disease control rate, adverse events, and serious adverse events. We plan to recruit 30 participants in 5.5 years from 23 Japanese institutions. The follow-up period is set as 1 year after completion of accrual. The study protocol was approved by the Japan Clinical Oncology Group Protocol Review Committee in December 2017. Ethical approval for this study was granted by Ethics Committee of each institute. Discussion If the primary endpoint is met, pazopanib will be regarded as a standard of care for paclitaxel-resistant patients for whom no standard second-line treatment is established. Trials registration Registry number: UMIN000031438 [http://www.umin.ac.jp/ctr/index.htm]. Date of Registration: 23/Feb/2018. Date of First Participant Enrollment: 8/Mar/2018.
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Affiliation(s)
- Kohei Oashi
- Department of Dermatology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama, 362-0806, Japan.
| | - Taro Shibata
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kenji Yokota
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiji Nakano
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Arata Tsutsumida
- Department of Dermatologic Oncology, Dermatology, Cancer Institute Hospital, Tokyo, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Kang Y, Bae J, Choi S, Jang KT, Yu J, Hong JY, Lim SY, Jeong HS. Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases. Ann Surg Oncol 2020; 27:3018-3027. [PMID: 32458324 DOI: 10.1245/s10434-020-08408-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas. METHODS This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner. RESULTS The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes. CONCLUSIONS For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.
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Affiliation(s)
- Yungjee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juyoung Bae
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeongil Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yong Hong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Moon IJ, Kim YJ, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. Clinicopathological and survival analyses of primary cutaneous angiosarcoma in an Asian population: prognostic value of the clinical features of skin lesions. Int J Dermatol 2020; 59:582-589. [PMID: 32141614 DOI: 10.1111/ijd.14828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Primary cutaneous angiosarcoma (CA) is a rare but aggressive tumor with a high rate of local recurrence. This study was designed to analyze the clinicopathological features of primary CA and identify factors of cutaneous manifestations associated with the prognosis of angiosarcoma. METHODS Medical records of 55 patients with primary CA were retrospectively analyzed to investigate clinical features, survivals, and prognostic factors. Anatomical location of tumor was classified to the scalp, face, and neck, and sites outside the head and neck. RESULTS Primary CA presented cutaneous nodules (31/55, 47.2%), patches (13/55, 23.6%), and indurated plaques (11/55, 20.0%). Nodular lesion was significantly more common in CA on the scalp compared to CA on sites outside the scalp. Histologically, tumors presenting as nodular lesions on the scalp was predominantly composed of solid sheets of large pleomorphic cells, whereas non-nodular lesions composed of tumor cells between collagen bundles forming irregular vascular spaces. Cutaneous angiosarcoma on the scalp showed a worse prognosis compared to CA on sites outside the scalp. Patients presenting clinical morphology with nodules and multiple skin lesions showed significantly reduced overall survival (OS). CONCLUSION In primary CA, location on the scalp, morphology with nodules, and multiplicity of skin lesions significantly affected survival outcomes.
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Affiliation(s)
- Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jae Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sakamoto R, Kajihara I, Miyauchi H, Maeda-Otsuka S, Yamada-Kanazawa S, Sawamura S, Kanemaru H, Makino K, Aoi J, Makino T, Fukushima S, Masuzawa M, Masuzawa M, Amoh Y, Hoshina D, Abe R, Ihn H. Inhibition of Endoglin Exerts Antitumor Effects through the Regulation of Non-Smad TGF-β Signaling in Angiosarcoma. J Invest Dermatol 2020; 140:2060-2072.e6. [PMID: 32142796 DOI: 10.1016/j.jid.2020.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/10/2020] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
Angiosarcoma is a rare malignant tumor derived from endothelial cells, and its prognosis is poor because advanced angiosarcoma is often resistant to taxane therapy. Endoglin (CD105) acts as a coreceptor for TGF-β signaling and is overexpressed in tumor-associated endothelial cells and enhances tumor angiogenesis. Numerous clinical trials are testing the effectiveness of anti-endoglin antibodies in various types of malignancies. Here, we investigated the role of endoglin in the pathogenesis of angiosarcoma and whether endoglin inhibition results in antitumor activity. Endoglin was overexpressed in angiosarcoma, and its inhibition was effective in promoting apoptosis and the suppression of migration, invasion, tube formation, and Warburg effect in angiosarcoma cells. Knockdown of endoglin activated caspase 3/7 that is essential for apoptosis, reduced survivin levels, and decreased paxillin and vascular endothelial cadherin phosphorylation and matrix metalloproteinase 2 and matrix metalloproteinase 9 activities in angiosarcoma cells. Although endoglin is a coreceptor that regulates TGF-β signaling, the antitumor effect of endoglin in angiosarcoma was not based on Smad signaling regulation but on non-Smad TGF-β signaling. Taken together, these results indicated that endoglin could be a novel therapeutic target for angiosarcoma.
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Affiliation(s)
- Ryoko Sakamoto
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ikko Kajihara
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Hitomi Miyauchi
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Saki Maeda-Otsuka
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Saori Yamada-Kanazawa
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Soichiro Sawamura
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisashi Kanemaru
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsunari Makino
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun Aoi
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamitsu Makino
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamiko Masuzawa
- Department of Dermatology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mikio Masuzawa
- Department of Molecular Diagnostics, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yasuyuki Amoh
- Department of Dermatology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Daichi Hoshina
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Riichiro Abe
- Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Chang C, Wu SP, Hu K, Li Z, Schreiber D, Oliver J, Givi B. Patterns of Care and Survival of Cutaneous Angiosarcoma of the Head and Neck. Otolaryngol Head Neck Surg 2020; 162:881-887. [PMID: 32043919 DOI: 10.1177/0194599820905495] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze the patterns of care and survival of cutaneous angiosarcomas of the head and neck. STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS The National Cancer Database was queried to select patients with cutaneous angiosarcoma of the head and neck between 2004 and 2015. For survival analysis, patients were included only if they received definitive treatment and complete data. Prognostic factors were analyzed by univariate and multivariable Cox regression. RESULTS We identified 693 patients diagnosed with head and neck angiosarcomas during the study period. The majority were male (n = 489, 70.6%) and elderly (median, 77 years). A total of 421 patients (60.8%) met the criteria for survival analyses. These patients were treated with surgery and radiation (n = 178, 42.3%), surgery alone (n = 138, 32.8%), triple-modality therapy (n = 48, 11.4%), surgery and chemotherapy (n = 29, 6.9%), and chemoradiation (n = 28, 6.7%). With a median follow-up of 29 months, the 3-year survival was 50.1%. Patients undergoing surgery had better median survival than those who did not (38.1 vs 21.0 months, P = .04). Age, comorbidity, tumor size, and surgical margins were significant factors in univariate analyses. On multivariable analysis, age ≥75 years (hazard ratio, 2.65; 95% CI, 1.80-3.88; P < .001) and positive margins (hazard ratio, 1.91; 95% CI, 1.44-2.51; P < .001) predicted worse overall survival. CONCLUSION Angiosarcoma of head and neck is a rare malignancy that affects the elderly. Surgical treatment with negative margins is associated with improved survival. Even with curative-intent multimodality treatment, the survival of patients aged ≥75 years is limited.
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Affiliation(s)
- Clifford Chang
- New York University Langone Health, New York, New York, USA
| | - S Peter Wu
- New York University Langone Health, New York, New York, USA
| | - Kenneth Hu
- New York University Langone Health, New York, New York, USA
| | - Zujun Li
- New York University Langone Health, New York, New York, USA
| | | | - Jamie Oliver
- New York University Langone Health, New York, New York, USA
| | - Babak Givi
- New York University Langone Health, New York, New York, USA
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Goldust M, Giulini M, Weidenthaler‐Barth B, Gupta M, Grabbe S, Schepler H. Increased risk of angiosarcoma secondary to cancer radiotherapy: Case series and review of the treatment options. Dermatol Ther 2020; 33:e13234. [DOI: 10.1111/dth.13234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/24/2019] [Accepted: 01/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad Goldust
- University of Rome Guglielmo Marconi Rome Rome Italy
- Department of Dermatology University Medical Center Mainz Mainz Germany
- University Hospital Basel Basel Switzerland
| | - Mario Giulini
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | | | - Mrinal Gupta
- Consultant Dermatologist Treatwell Skin Centre Jammu India
| | - Stephan Grabbe
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - Hadrian Schepler
- Department of Dermatology University Medical Center Mainz Mainz Germany
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Zhang C, Xu G, Liu Z, Xu Y, Lin F, Baklaushev VP, Chekhonin VP, Peltzer K, Mao M, Wang X, Wang G, Zhang C. Epidemiology, tumor characteristics and survival in patients with angiosarcoma in the United States: a population-based study of 4537 cases. Jpn J Clin Oncol 2019; 49:1092-1099. [PMID: 31612920 DOI: 10.1093/jjco/hyz113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Limited by sample size, angiosarcoma was rarely studied. We aimed to investigate the characteristics and prognosis of angiosarcoma in the National Cancer Institute's Surveillance, Epidemiology and End Results database. METHODS Patients who were diagnosed with primary angiosarcoma from 1973 to 2014 were extracted from the Surveillance, Epidemiology and End Results database. Kaplan-Meier analysis was used to estimate the overall survival, and the difference between groups was tested by the log-rank test. Multivariate Cox regression analyses were employed to identify prognostic factors for primary angiosarcoma. RESULTS A total of 4537 patients with angiosarcoma were included with the median age of 69 years. The median overall survival was 82.1 (95% confidence interval: 76.5-87.7) months. Overall 1-, 2- and 5-year survival rates were 55.2 ± 0.7, 41.0 ± 0.7 and 26.3 ± 0.7%, respectively. In the univariate analysis, age, gender, marital status, race, primary site, tumor grade, tumor size, Surveillance, Epidemiology and End Results historic stage and the surgery of primary site were significantly associated with overall survival. Multivariate Cox regression showed that factors including the patients older than 69 years, male, unmarried status, other primary sites, grades (III and IV), tumor size ≥ 5 cm, regional and distant stage and non-surgery were independently associated with poor survival. The results were consistent after excluding the patients in IV stages. CONCLUSIONS This large population-based study comprehensively described the survival rate and prognostic factors for angiosarcoma in the United States. Age, gender, marital status, primary sites, tumor grade and size and historic stage were determinants of survival, and surgery can improve the prognosis of patients with angiosarcoma.
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Affiliation(s)
- Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Guijun Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zheng Liu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Feng Lin
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Vladimir P Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Vladimir P Chekhonin
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Chou PY, Kao D, Denadai R, Huang CY, Lin CH, Lin CH. Anterolateral thigh free flaps for the reconstruction of scalp angiosarcoma - 18-year experience in Chang Gung memorial hospital. J Plast Reconstr Aesthet Surg 2019; 72:1900-1908. [PMID: 31519502 DOI: 10.1016/j.bjps.2019.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Scalp angiosarcoma is a rare and highly aggressive cutaneous malignancy with poor prognosis and high recurrence rate. Multimodality approach is currently the treatment protocol for resectable angiosarcoma, including wide local excision and postoperative radiation. This single-institution study reviews the 18-year experience of the surgical treatment of scalp angiosarcomas. METHODS A retrospective chart review was performed on patients with scalp angiosarcoma who received wide local excision and free flap reconstruction from 2001 to 2018. The type of free flap, safety margin, outer cortex burring, and dose for radiation were recorded. Kaplan-Meier plots were computed. RESULTS Eight male patients (mean age of 74.4 years old) were enrolled in the series. Tumor sizes ranged from 3 × 3 to 8 × 13 cm. All patients underwent wide local excision and outer cortex burring (cortical curettage). Seven (87.5%) scalp defects were reconstructed with anterolateral thigh free flap. All patients received adjuvant radiation therapy for tumor bed and margins. Chemotherapy was adopted for the management of local recurrence (37.5%) or distant metastasis (37.5%). The 2-year and 5-year survival rates are 72.9% and 38.9%, respectively, and 1-year and 2-year disease-free rates are 37.5% each. CONCLUSION Scalp angiosarcoma is a rare and highly aggressive cutaneous malignancy with poor prognosis. Anterolateral thigh free flap is a good reconstructive option due to its ability to cover large cutaneous defects with minimal need for skin grafting. Multimodal treatment protocol, including wide local excision with cortical curettage, and adjuvant radiation (regular basis) and chemotherapy (local recurrence or distant metastasis) may offer improved 1-year survival rate (100%).
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Affiliation(s)
- Pang-Yun Chou
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Dennis Kao
- Plastic Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Rafael Denadai
- Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chu-Yen Huang
- Surgery Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
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Ihara H, Kaji T, Katsui K, Miyake T, Waki T, Katayama N, Matsuzaki H, Yamasaki O, Kuroda M, Morizane S, Kanazawa S. Single institutional experience of radiation therapy for angiosarcoma of the scalp without cervical lymph node metastases: Impact of concurrent chemoradiation with maintenance chemotherapy using taxanes on patient prognosis. Mol Clin Oncol 2019; 11:498-504. [PMID: 31620281 DOI: 10.3892/mco.2019.1918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/10/2019] [Indexed: 11/05/2022] Open
Abstract
Cutaneous angiosarcoma is a rare aggressive malignant tumor. Concurrent chemoradiation (CCRT) with maintenance chemotherapy using taxanes is one of the primary treatments. The aim of the present study was to retrospectively analyze the efficacy of CCRT with maintenance chemotherapy using taxanes in localized angiosarcoma of the scalp without cervical lymph node metastases. A total of 19 patients treated with radiation therapy for localized angiosarcomas of the scalp without cervical lymph node metastases were enrolled. The overall survival (OS), progression-free survival (PFS), and local control (LC) rates were calculated using Kaplan-Meier analysis. Univariate analyses were performed for various potential prognostic factors for OS, PFS, and LC. The median radiation dose was 70 Gy (range, 60-70 Gy), and the fractional dose was 2 Gy. Radiation therapy alone, radiation therapy + interleukin-2, surgery + CCRT with maintenance chemotherapy, CCRT with maintenance chemotherapy, and CCRT without maintenance chemotherapy were administered to 2, 4, 2, 9 and 2 patients, respectively. The 1- and 3-year OS, PFS, and LC rates were 88 and 52%, 47 and 33%, and 74 and 56%, respectively. CCRT with maintenance chemotherapy and surgery were significant prognostic factors for PFS (P=0.036 and 0.025, respectively). Therefore, CCRT with maintenance chemotherapy using taxanes might be effective in treating localized angiosarcomas of the scalp without cervical lymph node metastases.
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Affiliation(s)
- Hiroki Ihara
- Department of Radiology, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
| | - Tatsuya Kaji
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tomoko Miyake
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
| | - Norihisa Katayama
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hidenobu Matsuzaki
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan
| | - Shin Morizane
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
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Jasper KD, Holloway CL, DeVries KJ, Truong PT. Local Relapse and Survival Outcomes in Patients with Scalp Sarcoma: A Retrospective Study of 95 Patients Treated in a Provincial Cancer Care Institution Over 25 Years. Cureus 2019; 11:e5236. [PMID: 31555498 PMCID: PMC6759421 DOI: 10.7759/cureus.5236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives There is limited literature on the optimal treatment of sarcoma arising in the scalp. This study evaluates local relapse (LR) and survival outcomes of patients with scalp sarcoma treated at a provincial cancer care institution. Methods A retrospective review of 95 patients with a primary diagnosis of scalp sarcoma referred from 1990-2015 was completed. Kaplan-Meier statistics were used to estimate LR-free survival (LRFS) and overall survival (OS). Survival curves were compared using log-rank tests. Regression analyses were performed using Cox proportional hazards model. Results The median age at diagnosis was 77 years. The most common histologies were angiosarcoma (27%), undifferentiated pleomorphic sarcoma (24%), and pleomorphic dermal sarcoma (21%). Final margins were 36% positive, 28% close, 31% negative, and 5% unknown. Of 73 patients treated with curative-intent, 32 (44%) experienced LR. Five-year LRFS was 56.0% and overall survival was 48.3%. Patients with close or positive margins who received pre- or post-operative radiotherapy (n=19) had similar LR risk compared to patients who did not (n=34) (five-year LRFS 41.8% vs 69.1%; p=0.145). On multivariate analysis, angiosarcoma was associated with a higher LR risk (Hazard ratio (HR) 12.06, p<0.001). The use of radiotherapy showed a trend towards reduced LR risk but did not reach statistical significance (HR 0.37, p=0.066). Conclusions Patients with scalp sarcoma have high risk of LR, particularly in cases with positive margins. Adjuvant radiation was not associated with improved local control for close or positive margins. Complete surgical excision to establish negative margins remains the primary standard treatment for patients with this rare disease.
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Affiliation(s)
- Katie D Jasper
- Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, University of British Columbia, Vancouver, CAN
| | - Caroline L Holloway
- Radiation Oncology, British Columbia Cancer Agency, Victoria Centre, University of British Columbia, Victoria, CAN
| | - Kimberly J DeVries
- Population Oncology, Cancer Surveillance & Outcomes, British Columbia Cancer Agency, Vancouver Centre, Vancouver, CAN
| | - Pauline T Truong
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
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Kawamura A, Kawamura T, Riddell M, Hikita T, Yanagi T, Umemura H, Nakayama M. Regulation of programmed cell death ligand 1 expression by atypical protein kinase C lambda/iota in cutaneous angiosarcoma. Cancer Sci 2019; 110:1780-1789. [PMID: 30801864 PMCID: PMC6500975 DOI: 10.1111/cas.13981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 12/28/2022] Open
Abstract
The expression of immune checkpoint proteins such as programmed cell death protein 1 (PD‐1) and its ligand (PD‐L1) has been shown to correlate with patient prognosis in many malignant cancers. The expression of PD‐L1 is controlled by c‐Myc; however, further upstream regulation of PD‐L1 expression is largely unknown. We have previously shown that atypical protein kinase C lambda/iota (aPKCλ) phosphorylates the Forkhead box protein O1 (FoxO1) transcription factor at Ser218 to suppress its DNA‐binding ability, thereby regulating c‐Myc expression and controlling physiologic and pathologic endothelial proliferation. The presence of phosphorylation of FoxO1 at Ser218 (pSer218 FoxO1) in cutaneous angiosarcoma (CAS) strongly correlates with poor patient prognosis. Here, we reported that patients with PD‐L1+ cells in CAS lesions showed significantly worse prognosis compared to those that were PD‐L1−. Expression of PD‐L1 correlated with that of aPKCλ or the presence of pSer218FoxO1. Moreover, suppression of aPKCλ expression or inhibition of its activity in HUVECs or AS‐M, an established human angiosarcoma cell line, resulted in decreased PD‐L1 expression. Our results suggest that combined treatment with immune checkpoint inhibitors and aPKCλ inhibitors could be a novel treatment strategy for CAS patients.
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Affiliation(s)
- Ai Kawamura
- Laboratory for Cell Polarity and Organogenesis, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Takuji Kawamura
- Laboratory for Cell Polarity and Organogenesis, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Meghan Riddell
- Laboratory for Cell Polarity and Organogenesis, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Takao Hikita
- Laboratory for Cell Polarity and Organogenesis, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Teruki Yanagi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Hiroshi Umemura
- Department of Dermatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Masanori Nakayama
- Laboratory for Cell Polarity and Organogenesis, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.,DFG Research Training Group, Membrane Plasticity in Tissue Development and Remodeling, GRK 2213, Philipps-Universität Marburg, Marburg, Germany
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48
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Reis E, Kalamaha K, Jia H, Fernandes HD. Angiosarcoma with Synchronous Cutaneous and Small Bowel Involvement: A Report of a Rare Presentation. Cureus 2018; 10:e3650. [PMID: 30723649 PMCID: PMC6351118 DOI: 10.7759/cureus.3650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Angiosarcomas are mesenchymal neoplasms of vascular origin that represent approximately 2% of soft tissue sarcomas. We discuss the case of a 75-year-old female who had presented with a purple nodular rash along the bilateral nasolabial folds. Upon further work-up, she was diagnosed with angiosarcoma, with the confirmed involvement of multi-focal sites. These included biopsy proven sites of the face and duodenum along with the radiographic involvement of the lungs, liver, and osseous tissue. We report this unique presentation of a rare malignancy and the treatment course with radiation, paclitaxel, and bevacizumab. We also discuss the implications of her co-morbid liver cirrhosis and gastric antral vascular ectasia (GAVE) in terms of its influence on the development of the angiosarcoma and treatment response.
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Affiliation(s)
- Erin Reis
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, USA
| | - Kadra Kalamaha
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, USA
| | | | - Hermina D Fernandes
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Bismarck, USA
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Lee KC, Chuang SK, Philipone EM, Peters SM. Characteristics and Prognosis of Primary Head and Neck Angiosarcomas: A Surveillance, Epidemiology, and End Results Program (SEER) Analysis of 1250 Cases. Head Neck Pathol 2018; 13:378-385. [PMID: 30357539 PMCID: PMC6684669 DOI: 10.1007/s12105-018-0978-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/19/2018] [Indexed: 01/10/2023]
Abstract
Head and neck angiosarcomas (HN-AS) are rare malignancies with a poor prognosis relative to other soft tissue sarcomas. To date, the HN-AS literature has been limited to short reports and single-institution experiences. This study evaluated patients registered with the Surveillance, Epidemiology, and End Results (SEER) program who had been diagnosed with a primary HN-AS. Predictors were drawn from demographic and baseline tumor characteristics. Outcomes were survival months and cause of death. Kaplan-Meier analyses were used to estimate overall (OS) and disease-specific survival (DSS) rates. Cox proportional hazards regression models were used for multivariate analyses. A total of 1250 patients (mean age 73.3 years) were identified, and nearly all lesions (93.5%) were cutaneous. Two- and 5-year OS rates were 47.3% (95% CI 44.3-50.3) and 26.5% (95% CI 23.7-29.3), while 2- and 5-year DSS rates were 66.6% (95% CI 63.6-69.6) and 48.3% (95% CI 44.5-52.1). In the univariate analyses, age, race, tumor grade, tumor size, AJCC stage, SEER historic stage, and surgery were significant predictors of both OS and DSS. Multivariate regression revealed that independent predictors of poor OS and DSS were older age [OS: HR 1.04 (95% CI 1.02-1.05), p < 0.01; DSS: HR 1.03 (95% CI 1.01-1.05), p < 0.01], increased tumor size [OS: HR 1.01 (95% CI 1.01-1.01), p < 0.01; DSS: HR 1.01 (95% CI 1.01-1.02), p < 0.01], and distant disease [OS: HR 2.97 (95% CI 1.65-5.34), p < 0.01; DSS: HR 4.99 (95% CI 2.50-9.98), p < 0.01]. Age, tumor size, and disease extent were determinants of HN-AS survival. When all other factors were controlled, lower histologic grade and surgery did not improve the risk of death.
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Affiliation(s)
- Kevin C. Lee
- 0000000419368729grid.21729.3fDivision of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY USA
| | - Sung-Kiang Chuang
- 0000 0004 1936 8972grid.25879.31Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA USA ,0000 0004 0458 7945grid.413190.eBrockton Oral and Maxillofacial Surgery Inc., Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA USA
| | - Elizabeth M. Philipone
- 0000000419368729grid.21729.3fDivision of Oral and Maxillofacial Pathology, NewYork-Presbyterian/Columbia University Irving Medical Center, 630 West 168th Street PH15-1562W, New York, NY 10032 USA
| | - Scott M. Peters
- 0000000419368729grid.21729.3fDivision of Oral and Maxillofacial Pathology, NewYork-Presbyterian/Columbia University Irving Medical Center, 630 West 168th Street PH15-1562W, New York, NY 10032 USA
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50
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Park SO, Son Y, Kim IK, Jin US, Chang H. Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction. Head Neck 2018; 40:2399-2408. [PMID: 30175898 DOI: 10.1002/hed.25347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/12/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Monitoring free muscle flaps with skin grafts is difficult. To intensify the monitoring process for this type of flap, a small skin paddle was included in the flap and analyzed its effects. METHODS A retrospective analysis of all patients who underwent scalp reconstruction with a free latissimus dorsi flap and skin graft between 1994 and 2016 was conducted. Flap monitoring was proceeded using a combination of clinical examination and handheld Doppler for both types of flaps. RESULTS A total of 71 patients were included in this study and were divided into a study group (skin paddle included; n = 30) and a control group (conventional method; n = 41). The time between initial surgery to pedicle exploration was significantly shorter in the study group (11.3 ± 2.5 vs 79.8 ± 42.6 hours; P = .024). The flap salvage rate was significantly higher in the study group (100% vs 16.7%; P = .048). CONCLUSION The efficacy of flap monitoring and flap salvage outcomes were improved by including a small monitoring skin flap.
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Affiliation(s)
- Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Research Institute of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoosung Son
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
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