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Mannelli G, Bassani S, Cosi G, Fermi M, Gazzini L, Liberale C, Mazzetti L, Parrinello G, Saibene AM, Molteni G, Comini LV. Global frequency and distribution of head and neck sarcomas in adulthood: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:2553-2567. [PMID: 38381151 DOI: 10.1007/s00405-024-08477-4] [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: 09/26/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Head and neck sarcomas (HNS) constitute a rare and heterogeneous cancer entity. Management remains a challenge due their rarity and different biological behaviour among tens of subtypes. This systematic review aimed to describe HNS global frequency and distribution in adulthood. METHODS A systematic review was performed using PICOTS search strategies for qualitative question and it was written in accordance with PRISMA 2020 Statement. 70,653 publications were identified, and 15 variables were evaluated for a total of 2428 patients. RESULTS We identified 47 studies from 21 different countries from 5 different continents. Most of studies (83.3%) were performed in single institutions and America and Asia overruled for number of papers included (21 and 10, respectivelly). Osteosarcoma was more frequent, followed by chondrosarcoma, angiosarcoma and malignant fibrous histiocytoma. Early stage accounted for almost 80% of cases; advanced stage prevailed in developing countries. 1783 patients (90.1%) underwent surgery and 780 (39.4%) had adjuvant therapy. 50.8% of patients experienced tumour recurrence and the lowest mortality rate was reported in Europe (29.9%). CONCLUSIONS HNS holds a relative poor prognosis possibly explained by the heterogeneity of the disease. Treatment of HNS has shown to be highly diverse among different countries, underlining the importance of uniformed treatment guidelines to achieve better patient management and to improve survival outcomes.
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Affiliation(s)
- Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Bassani
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Ginevra Cosi
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Fermi
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Carlotta Liberale
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Luca Mazzetti
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giampiero Parrinello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Martino Polyclinc Hospital, Genoa, Italy
| | - Alberto Maria Saibene
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology Department, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università Degli Studi di Milano, Milan, Italy
| | - Gabriele Molteni
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Lara Valentina Comini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria.
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale, 142-KM 3.95, 10060, Candiolo, TO, Italy.
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Palassini E, Baldi GG, Sulfaro S, Barisella M, Bianchi G, Campanacci D, Fiore M, Gambarotti M, Gennaro M, Morosi C, Navarria F, Palmerini E, Sangalli C, Sbaraglia M, Trama A, Asaftei S, Badalamenti G, Bertulli R, Bertuzzi AF, Biagini R, Bonadonna A, Brunello A, Callegaro D, Cananzi F, Cianchetti M, Collini P, Comandini D, Curcio A, D'Ambrosio L, De Pas T, Dei Tos AP, Ferraresi V, Ferrari A, Franchi A, Frezza AM, Fumagalli E, Ghilli M, Greto D, Grignani G, Guida M, Ibrahim T, Krengli M, Luksch R, Marrari A, Mastore M, Merlini A, Milano GM, Navarria P, Pantaleo MA, Parafioriti A, Pellegrini I, Pennacchioli E, Rastrelli M, Setola E, Tafuto S, Turano S, Valeri S, Vincenzi B, Vitolo V, Ivanescu A, Paloschi F, Casali PG, Gronchi A, Stacchiotti S. Clinical recommendations for treatment of localized angiosarcoma: A consensus paper by the Italian Sarcoma Group. Cancer Treat Rev 2024; 126:102722. [PMID: 38604052 DOI: 10.1016/j.ctrv.2024.102722] [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: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
Angiosarcoma (AS) represents a rare and aggressive vascular sarcoma, posing distinct challenges in clinical management compared to other sarcomas. While the current European Society of Medical Oncology (ESMO) clinical practice guidelines for sarcoma treatment are applicable to AS, its unique aggressiveness and diverse tumor presentations necessitate dedicated and detailed clinical recommendations, which are currently lacking. Notably, considerations regarding surgical extent, radiation therapy (RT), and neoadjuvant/adjuvant chemotherapy vary significantly in localized disease, depending on each different site of onset. Indeed, AS are one of the sarcoma types most sensitive to cytotoxic chemotherapy. Despite this, uncertainties persist regarding optimal management across different clinical presentations, highlighting the need for further investigation through clinical trials. The Italian Sarcoma Group (ISG) organized a consensus meeting on April 1st, 2023, in Castel San Pietro, Italy, bringing together Italian sarcoma experts from several disciplines and patient representatives from "Sofia nel Cuore Onlus" and the ISG patient advocacy working group. The objective was to develop specific clinical recommendations for managing localized AS within the existing framework of sarcoma clinical practice guidelines, accounting for potential practice variations among ISG institutions. The aim was to try to standardize and harmonize clinical practices, or at least highlight the open questions in the local management of the disease, to define the best evidence-based practice for the optimal approach of localized AS and generate the recommendations presented herein.
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Affiliation(s)
- Elena Palassini
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | | | | | - Marta Barisella
- Department of Pathology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giuseppe Bianchi
- Department of Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Domenico Campanacci
- Department of Surgery, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Marco Fiore
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Gambarotti
- Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Gennaro
- Department of Surgery, Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Federico Navarria
- Department of Radiation Oncology, IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Pordenone, Italy
| | - Emanuela Palmerini
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Sangalli
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marta Sbaraglia
- Department of Pathology, Università di Padova, Padova, Italy
| | - Annalisa Trama
- Department of Edidemiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sebastian Asaftei
- Department of Pediatric Oncology, Ospedale Infantile Regina Margherita , Torino
| | - Giuseppe Badalamenti
- Department of Medical Oncology, Azienda Universitaria Policlinico Giaccone, Palermo, Italy
| | - Rossella Bertulli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alexia Francesca Bertuzzi
- Department of Medical Oncology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Roberto Biagini
- Department of Oncological Orthopedics, IRCCS Istituto Nazionale Tumori Regina Elena - Istituti Fisioterapici Ospitalieri, Roma, Italy
| | - Angela Bonadonna
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Pordenone, Italy
| | - Antonella Brunello
- Department of Medical Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Dario Callegaro
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ferdinando Cananzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Cancer Center, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Danila Comandini
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Annalisa Curcio
- Department of Surgery, Ospedale Morgagni e Pierantoni, Forlì, Italy
| | - Lorenzo D'Ambrosio
- Department of Medical Oncology, Ospedale S. Luigi, Orbassano, Torino, Italy
| | - Tommaso De Pas
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS Istituto Nazionale Tumori Regina Elena - Istituti Fisioterapici Ospitalieri, Roma, Italy
| | - Andrea Ferrari
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Franchi
- Department of Pathology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Anna Maria Frezza
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elena Fumagalli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Matteo Ghilli
- Breast Centre, Department of Oncology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniela Greto
- Department of Radiation Therapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giovanni Grignani
- Department of Medical Oncology, Azienda Ospedaliera Univerisitaria Città della Salute e della Scienza, Torino, Italy
| | - Michele Guida
- Department of Medical Oncology, IRCCS Istituto Tumori di Bari Giovanni Paolo II, Bari, Italy
| | - Toni Ibrahim
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Krengli
- Department of Radiation Therapy, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Roberto Luksch
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Marrari
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alessandra Merlini
- Department of Medical Oncology, Ospedale S. Luigi, Orbassano, Torino, Italy
| | | | - Piera Navarria
- Department of Radiation Therapy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Maria Abbondanza Pantaleo
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna', University of Bologna, Bologna, Italy
| | | | - Ilaria Pellegrini
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marco Rastrelli
- Department of Surgical Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), Università di Padova, Padova, Italy
| | - Elisabetta Setola
- Department of Medical Oncology, Istituto Europeo Oncologia, Milano, Italy
| | - Salvatore Tafuto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori G. Pascale, Napoli, Italy
| | - Salvatore Turano
- Department of Medical Oncology, Azienda Ospedaliera S.S. Annunziata, Cosenza, Italy
| | - Sergio Valeri
- Department of Surgery, Università Campus Bio-Medico, Roma, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - Viviana Vitolo
- Department of Radiation Therapy, Centro Nazionale di Adroterapia Oncologica, Fondazione CNAO, Pavia, Italy
| | | | | | - Paolo Giovanni Casali
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Hama Y, Tsukamoto T, Tate E. High-dose planned adaptive helical tomotherapy for cutaneous angiosarcoma of the scalp. Strahlenther Onkol 2024; 200:123-127. [PMID: 37264179 DOI: 10.1007/s00066-023-02093-7] [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: 03/25/2022] [Accepted: 04/26/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this study was to investigate the feasibility and effectiveness of high-dose planned adaptive intensity-modulated radiation therapy (IMRT) with helical tomotherapy (HT) for cutaneous angiosarcoma (cAS) of the scalp. METHODS This retrospective cross-sectional included a total of 12 consecutive patients with cAS of the scalp who underwent high-dose planned adaptive IMRT with HT. Prescribed doses were 72.5-74 Gy in 35-37 fractions for the gross tumor volume plus a 1-2 mm margin (PTV1), 58-60 Gy in 29-30 fractions for the clinical target volume plus a 2-3 mm margin (PTV2), and 46 Gy in 23 fractions for the clinical target volume plus a 5-15 mm margin (PTV3) over periods of 7.5, 6 and 4.5 weeks, respectively. RESULTS The estimated 1‑year and 2‑year overall survival rate were 65.6% and 27.3%, respectively, and the local progression-free survival at 2 years was 74.1%. All local recurrences were either in or marginal to the PTV2 or PTV3. No local recurrence was observed in the PTV1. All patients tolerated the treatment without grade 3 or higher adverse events during the radiotherapy period. No late adverse events were observed during the follow-up period. CONCLUSION Planned adaptive high-dose IMRT with HT has the potential to improve local control rate without increasing adverse events.
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Affiliation(s)
- Yukihiro Hama
- Departments of Radiology, Edogawa Hospital, 2-24-18 Higashikoiwa, 133-0052, Tokyo, Japan.
| | - Toshiro Tsukamoto
- Department of Dermatology, Chiba University Hospital, 1-8-1 Inohana, 260-8670, Chiba, Japan
| | - Etsuko Tate
- Departments of Radiology, Edogawa Hospital, 2-24-18 Higashikoiwa, 133-0052, Tokyo, Japan
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Iwai T, Imagumbai T, Hiraoka S, Kishi T, Okabayashi S, Ashida R, Mitsuyoshi T, Matsuo Y, Ishigaki T, Mizowaki T, Kokubo M. Clinical outcomes of scalp or face angiosarcoma treatment with intensity-modulated radiotherapy: a multicenter study. JOURNAL OF RADIATION RESEARCH 2024; 65:78-86. [PMID: 37996084 PMCID: PMC10803163 DOI: 10.1093/jrr/rrad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/04/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023]
Abstract
Combined modality therapy, including radiotherapy (RT), is a common treatment for scalp or face angiosarcoma. Although intensity-modulated radiotherapy (IMRT) can deliver homogeneous doses to the scalp or face, clinical data are limited. This multicenter study aimed to evaluate scalp or face angiosarcoma treated with definitive or post-operative IMRT. We retrospectively analyzed data from patients who received IMRT for scalp or face angiosarcoma at three institutions between January 2015 and March 2020. Local control (LC) rate, overall survival (OS), progression-free survival (PFS), recurrence patterns and toxicity were evaluated. Fifteen patients underwent IMRT during the study period. Definitive RT was performed on 10 patients and post-operative RT was performed on 5 patients. The 1-year LC rate was 85.7% (95% confidence interval [CI], 53.9-96.2%). The 1-year OS and PFS rates were 66.7% (95% CI, 37.5-84.6%) and 53.3% (95% CI, 26.3%-74.4%), respectively. Univariate analysis revealed that a clinical target volume over 500 cm3 was associated with poor LC. Distant metastasis was the most common recurrence pattern. All patients experienced Grade 2 or 3 radiation dermatitis, and five patients experienced grade ≥ 3 skin ulceration. One patient who underwent maintenance therapy with pazopanib developed Grade 5 skin ulceration. Fisher's exact test showed that post-operative RT was significantly associated with an increased risk of skin ulceration of grade ≥ 3. These results demonstrate that IMRT is a feasible and effective treatment for scalp or face angiosarcoma, although skin ulceration of grade ≥ 3 is a common adverse event in patients who receive post-operative RT.
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Affiliation(s)
- Takahiro Iwai
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Minamimachi 21-1, Minatojima, Chuo-ku, Kobe 650-0047, Hyogo, Japan
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Toshiyuki Imagumbai
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Minamimachi 21-1, Minatojima, Chuo-ku, Kobe 650-0047, Hyogo, Japan
| | - Shinya Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Takahiro Kishi
- Department of Radiation Oncology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, 543-8555, Osaka, Japan
| | - Shun Okabayashi
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Minamimachi 21-1, Minatojima, Chuo-ku, Kobe 650-0047, Hyogo, Japan
| | - Ryo Ashida
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Minamimachi 21-1, Minatojima, Chuo-ku, Kobe 650-0047, Hyogo, Japan
| | - Takamasa Mitsuyoshi
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Minamimachi 21-1, Minatojima, Chuo-ku, Kobe 650-0047, Hyogo, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan
| | - Takashi Ishigaki
- Department of Radiation Oncology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, 543-8555, Osaka, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Minamimachi 21-1, Minatojima, Chuo-ku, Kobe 650-0047, Hyogo, Japan
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Niwa M, Tomita N, Takaoka T, Takano H, Makita C, Matsuo M, Adachi S, Oshima Y, Yamamoto S, Kuno M, Miyakawa A, Okazaki D, Torii A, Kita N, Takano S, Nakamura M, Kato H, Morita A, Hiwatashi A. Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study. Cancers (Basel) 2023; 15:3696. [PMID: 37509356 PMCID: PMC10378060 DOI: 10.3390/cancers15143696] [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: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Angiosarcoma of the scalp and face (ASF) is a rare, aggressive tumor often treated with multimodal therapy, including radiation therapy (RT). This study assessed RT outcomes for ASF and identified prognostic factors. Data from 68 non-metastatic ASF patients undergoing RT with or without other therapies were analyzed. Median radiation dose was 66 Gy in 33 fractions (interquartile range (IQR) 60-70 Gy in 28-35 fractions). Local control (LC), progression-free survival (PFS), and overall survival (OS) rates were calculated using Kaplan-Meier analysis. Multivariate analyses and adverse event evaluation were conducted. Median patient age was 75 years (IQR 71-80 years), with a median follow-up of 17 months (IQR 11-42 months). One-/three-year LC rates were 57/37%, PFS rates were 44/22%, and OS rates were 81/44%. Multivariate analyses showed that an equivalent dose in a 2 Gy fraction (EQD2) >66 Gy correlated with improved LC (HR 2.35, 95% CI 1.03-5.32, p = 0.041). Combining chemotherapy (HR 2.43, 95% CI 1.08-5.46, p = 0.032) or surgery (HR 2.41, 95% CI 1.03-5.59, p = 0.041) improved PFS. No factors influenced OS. Late grade 3+ toxicities occurred in 1%, with one patient developing a grade 4 skin ulcer. These findings suggest that EQD2 > 66 Gy and combining chemotherapy or surgery can enhance LC or PFS in ASF. Further prospective studies are needed to determine the optimal treatment strategy for this rare malignancy, particularly in elderly patients.
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Affiliation(s)
- Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hirota Takano
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Chiyoko Makita
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Masayuki Matsuo
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Sou Adachi
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Yukihiko Oshima
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Shintaro Yamamoto
- Department of Radiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya 457-8510, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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6
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Pilavaki P, Panagi M, Arifi S, Jones RL, Stylianopoulos T, Constantinidou A. Exploring the landscape of immunotherapy approaches in sarcomas. Front Oncol 2023; 12:1069963. [PMID: 36686827 PMCID: PMC9853527 DOI: 10.3389/fonc.2022.1069963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Sarcomas comprise a heterogenous group of malignancies, of more than 100 different entities, arising from mesenchymal tissue, and accounting for 1% of adult malignancies. Surgery, radiotherapy and systemic therapy constitute the therapeutic armamentarium against sarcomas, with surgical excision and conventional chemotherapy, remaining the mainstay of treatment for local and advanced disease, respectively. The prognosis for patients with metastatic disease is dismal and novel therapeutic approaches are urgently required to improve survival outcomes. Immunotherapy, is a rapidly evolving field in oncology, which has been successfully applied in multiple cancers to date. Immunomodulating antibodies, adoptive cellular therapy, cancer vaccines, and cytokines have been tested in patients with different types of sarcomas through clinical trials, pilot studies, retrospective and prospective studies. The results of these studies regarding the efficacy of different types of immunotherapies in sarcomas are conflicting, and the application of immunotherapy in daily clinical practice remains limited. Additional clinical studies are ongoing in an effort to delineate the role of immunotherapy in patients with specific sarcoma subtypes.
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Affiliation(s)
- Pampina Pilavaki
- Medical School, University of Cyprus, Nicosia, Cyprus,Medical Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - Myrofora Panagi
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering University of Cyprus, Nicosia, Cyprus
| | - Samia Arifi
- Medical Oncology Department, Hassan II University Hospital/Faculty of Medicine and Pharmacy University of Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Robin L. Jones
- Sarcoma Unit, Royal Marsden National Health Service (NHS) Foundation Trust, London, London, United Kingdom,Sarcoma Clinical Trial Unit, Institute of Cancer Research, London, United Kingdom
| | - Triantafyllos Stylianopoulos
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering University of Cyprus, Nicosia, Cyprus,*Correspondence: Anastasia Constantinidou, ; Triantafyllos Stylianopoulos,
| | - Anastasia Constantinidou
- Medical School, University of Cyprus, Nicosia, Cyprus,Medical Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus,Cyprus Cancer Research Institute, Nicosia, Cyprus,*Correspondence: Anastasia Constantinidou, ; Triantafyllos Stylianopoulos,
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7
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Li Y, Li C, Wang J, Wang X. Scalp angiosarcoma with skull roof infiltration and metastasis to the lung. Indian J Dermatol 2022; 67:315. [PMID: 36386099 PMCID: PMC9644800 DOI: 10.4103/ijd.ijd_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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8
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The Management and Prognosis of Facial and Scalp Angiosarcoma: A Retrospective Analysis of 15 Patients. Ann Plast Surg 2020; 83:55-62. [PMID: 31192879 DOI: 10.1097/sap.0000000000001865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angiosarcomas are extremely aggressive malignant tumors that arise from vascular endothelial cells. The risk factors, etiology, prognostic factors, and optimal management strategies for angiosarcomas are as yet unknown. METHODS We retrospectively analyzed data from 15 patients who were treated in Asan Medical Center, Seoul, Republic of Korea, in the past 12 years, to assess the effect of different treatment modalities and reconstructive methods on the locoregional recurrence, metastasis, and overall survival. RESULTS A total of 15 patients were identified (median age at diagnosis, 72 years; range, 61-82 years). Median tumor size was 6 cm. Median follow-up was 287 days. The median overall survival was 14.96 months; a total of 13 (87%) patients had died by the end of the study.The median locoregional recurrence, metastasis, and overall survival were 7.3, 6.5, and 16.7 months, respectively. On univariate analysis, the use of adjuvant therapy after surgery (vs surgery without adjuvant therapy) was associated with delayed median time to detection of recurrence (7.9 months vs 3.1 months, respectively; P = 0.825), delayed median time to metastasis (8.7 months vs 3.1 months, respectively; P = 0.191), and better median overall survival (7.3 months vs 3.1 months, respectively; P = 0.078).The use of flap versus skin graft as a reconstructive method was associated with delayed median recurrence (8.75 vs 7.32 months, respectively; P = 0.274) and earlier median metastasis (3.75 vs 6.53 months, respectively; P = 0.365), but the same median overall survival of 16.7 months (P value: 0.945) and tumor smaller or bigger than 5 cm show earlier median time to detection of recurrence (4.17-7.32 months; P = 0.41), earlier median time to metastasis (3.75-6.53 months; P = 0.651), but better median overall survival of 18.21 versus 16.7 months, respectively (P = 0.111). CONCLUSIONS Multimodal treatment that combines surgery with adjuvant therapy is the best management strategy that influences survival positively in patients with angiosarcoma. The study shows that the reconstructive method does not affect the prognosis in these patients. So it is better to choose the simplest suitable resection and reconstructive method with the least complications and to avoid unnecessary procedures.
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9
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Bönisch N, Langan EA, Terheyden P. [Cutaneous angiosarcoma : Radiochemotherapy with liposomal pegylated doxorubicin]. Hautarzt 2019; 70:700-706. [PMID: 31428802 DOI: 10.1007/s00105-019-4462-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Whilst cutaneous angiosarcoma is rare tumour which primarily affects elderly patients, its management presents a significant therapeutic challenge. Indeed, complete surgical excision is often not possible due to the location and the diffuse and extensive nature of the tumour. Therefore, current treatment strategies often include chemo- and/or radiotherapy. METHODS We report our experience of combined chemo- and radiotherapy in the clinical course of 6 patients with cutaneous angiosarcoma who were treated between 2007 and 2018. RESULTS All patients presented non-resectable tumours and were treated with radiotherapy in combination with the administration of liposomal, pegylated doxrubicin (25 mg/m2 every 2 weeks). The mean duration of progression-free survival was 8 months (5-14 months), corresponding to an overall survival of 13 months (13-34 months). A partial response was seen in 4 patients and 1 patient developed progressive disease. One patient abandoned therapy after one administration. Two patients developed severe adverse events which led to termination of therapy after 1.5 months and 7 months, i.e. after 4 and 15 cycles respectively. DISCUSSION Combined radio- and chemotherapy with liposomal, pegylated doxorubicin is a useful therapeutic option in the management of cutaneous angiosarcoma. Given the short-lived response rate, new treatment options are urgently required.
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Affiliation(s)
- N Bönisch
- Klinik für Dermatologie, Universität zu Lübeck, Lübeck, Deutschland
| | - E A Langan
- Klinik für Dermatologie, Universität zu Lübeck, Lübeck, Deutschland.,Dermatological Science, University of Manchester, Manchester, Großbritannien
| | - P Terheyden
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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10
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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: 0.8] [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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11
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Individual multi-catheter mould technique in high-dose-rate brachytherapy - personalized approach in treating multifocal angiosarcoma of the face. J Contemp Brachytherapy 2019; 11:337-342. [PMID: 31523234 PMCID: PMC6737578 DOI: 10.5114/jcb.2019.87144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/02/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose The aim of this study was to report individual surface mould multi-catheter high-dose-rate (IMM HDR) application as a salvage treatment for a head and neck angiosarcoma patient, previously treated with surgery followed by external beam radiotherapy. Material and methods A 74-year-old male reported to our center with an uncommon malignant neoplasm of blood vessels. The patient was qualified for a wide local excision (WLE) of tumor with simultaneous reconstruction using a free-flap collected from the patient's thigh. After surgery, the patient was qualified for adjuvant external-beam radiotherapy (EBRT). Volumetric arc therapy (VMAT; RapidArc®, Varian Medical Systems) was used to deliver 52.8 Gy/1.6 Gy in 33 fractions. Overall treatment time was 51 days. Six months after radiotherapy, an incisional biopsy of non-healing ulcer of the nasal bridge revealed angiosarcoma. Wide local excision with skin graft reconstruction was planned. Due to multifocal disease and lack of possibility for further margin, the resection surgery was completed after skin graft reconstruction from the right thigh. Surface IMM HDR was considered as an alternative option for further treatment. Total dose of 48 Gy (12 fractions) was planned. Results One month after surface IMM HDR, healing process of the skin was observed in the treated regions and six months later, the irradiated areas recovered. General condition of the patient deteriorated two years after diagnosis and one year after HDR. He was hospitalized to receive palliative care. Conclusions HDR brachytherapy may be a valuable option for angiosarcoma treatment. Difficult lesion location may yield non-radical surgery. Surface IMM HDR provides highly conformal plan and allow adjusting the dose to individual clinical situation.
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12
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Clinical Outcomes and Prognostic Features of Angiosarcoma: Significance of Prior Radiation Therapy. Clin Oncol (R Coll Radiol) 2019; 31:232-241. [PMID: 30718086 DOI: 10.1016/j.clon.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Abstract
AIMS Angiosarcoma is a rare and aggressive malignancy with a poor prognosis. There is limited literature describing prognostic factors and guidelines for treatment. We aim to describe outcomes in angiosarcoma, including the impact of patient-, tumour- and treatment-related factors on prognosis. MATERIALS AND METHODS Patients with non-metastatic angiosarcoma diagnosed between 2008 and 2017 were retrospectively reviewed. Univariable and multivariable Cox proportional hazards methods were used to evaluate factors associated with locoregional recurrence, distant failure and overall survival. The Kaplan-Meier method and log-rank statistics were used to compare outcomes among patients with and without a history of prior radiation therapy. RESULTS The cohort included 65 patients. The median age at diagnosis was 68 years (35-93). Nineteen patients had a history of receiving prior radiation therapy at the anatomic location of their angiosarcoma. Treatment modalities included surgery (n = 19), surgery + radiation therapy (n = 12), surgery + chemotherapy (n = 8), chemotherapy + radiation therapy (n = 7) and all three modalities (n = 14). The median follow-up was 18 (2-192) months. The 2-year locoregional control, distant control and overall survival were 61.8, 63.6 and 58.9%, respectively. On multivariable analysis, a history of previous radiation therapy was associated with inferior outcomes with respect to locoregional recurrence (hazard ratio 89.67, 95% confidence interval 8.45-951.07, P < 0.001), distant failure (hazard failure 3.74, 95% confidence interval 1.57-8.91, P = 0.003) and overall survival (hazard ratio 3.89, 95% confidence interval 1.56-9.60, P = 0.003). In patients with primary angiosarcoma, the rates of locoregional control, distant control and overall survival were 72.4, 73.4 and 65.1%, respectively, compared with 31.9, 41.1 and 45.1% in patients with radiation therapy-induced angiosarcoma (P = 0.001). CONCLUSION Angiosarcomas that arise as a result of previous radiation therapy have worse outcomes compared with primary angiosarcomas. Although selection bias and compromise of clinical care in radiation therapy-induced angiosarcoma are partially to blame, differences in genomic profiles of the tumours need to be characterised to evaluate the underlying biological differences, as this may guide future treatment management. This study adds to the existing body of literature on angiosarcoma. Results from the current study are presented alongside previously published data to further characterise outcomes and prognostic factors on this rare and aggressive malignancy.
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13
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Fujisawa Y, Yoshino K, Fujimura T, Nakamura Y, Okiyama N, Ishitsuka Y, Watanabe R, Fujimoto M. Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor. Front Oncol 2018; 8:46. [PMID: 29552543 PMCID: PMC5840142 DOI: 10.3389/fonc.2018.00046] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/14/2018] [Indexed: 01/26/2023] Open
Abstract
The most widely accepted treatment for cutaneous angiosarcoma (CAS) is wide local excision and postoperative radiation to decrease the risk of recurrence. Positive surgical margins and large tumors (T2, >5 cm) are known to be associated with poor prognosis. Moreover, T2 tumors are known to be associated with positive surgical margins. According to previous reports, the majority of CAS patients in Japan had T2 tumors, whereas less than half of the patients in the studies from western countries did so. Consequently, the reported 5-year overall survival of Japanese CAS patients without distant metastasis was only 9%, lower than that for stage-IV melanoma. For patients with T2 tumors, management of subclinical metastasis should be considered when planning the initial treatment. Several attempts to control subclinical metastasis have been reported, such as using adjuvant/neoadjuvant chemotherapy in addition to conventional surgery plus radiation. Unfortunately, those attempts did not show any clinical benefit. Besides surgery, new chemotherapeutic approaches for advanced CAS have been introduced in the past couple of decades, such as paclitaxel and docetaxel. We proposed the use of chemoradiotherapy (CRT) using taxanes instead of surgery plus radiation for patients with T2 tumors without distant metastasis and showed a high response ratio with prolonged survival. However, this prolonged survival was seen only in patients who received maintenance chemotherapy after CRT, indicating that continuous chemotherapy is mandatory to control subclinical residual tumors. With the recent development of targeted drugs for cancer, many potential drugs for CAS are now available. Given that CAS expresses a high level of vascular endothelial growth factor (VEGF) receptor, drugs that target VEGF signaling pathways such as anti-VEGF monoclonal antibody and tyrosine kinase inhibitors are also promising, and several successful treatments have been reported. Besides targeted drugs, several new cytotoxic anticancer drugs such as eribulin or trabectedin have also been shown to be effective for advanced sarcoma. However, most of the clinical trials did not include a sufficient number of CAS patients. Therefore, clinical trials focusing only on CAS should be performed to evaluate the effectiveness of these new drugs.
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Affiliation(s)
| | - Koji Yoshino
- Dermatology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | | | | | - Naoko Okiyama
- Dermatology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Rei Watanabe
- Dermatology, University of Tsukuba, Tsukuba, Ibaraki, Japan
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14
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Tsuneki M, Kinjo T, Mori T, Yoshida A, Kuyama K, Ohira A, Miyagi T, Takahashi K, Kawai A, Chuman H, Yamazaki N, Masuzawa M, Arakawa H. Survivin: A novel marker and potential therapeutic target for human angiosarcoma. Cancer Sci 2017; 108:2295-2305. [PMID: 28845553 PMCID: PMC5665764 DOI: 10.1111/cas.13379] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022] Open
Abstract
Human angiosarcoma is a rare malignant vascular tumor associated with extremely poor clinical outcome and generally arising in skin of the head and neck region. However, little is known about the molecular pathogeneses and useful immunohistochemical markers of angiosarcoma. To investigate the mechanisms of angiosarcoma progression, we collected 85 cases of human angiosarcoma specimens with clinical records and analyzed ISO-HAS-B patient-derived angiosarcoma cells. As control subjects, 54 cases of hemangioma and 34 of pyogenic granuloma were collected. Remarkably, consistent with our recent observations regarding the involvement of survivin expression following Hippo pathway inactivation in the neoplastic proliferation of murine hemangioendothelioma cells and human infantile hemangioma, nuclear survivin expression was observed in all cases of angiosarcoma but not in hemangiomas and pyogenic granulomas, and the Hippo pathway was inactivated in 90.3% of yes-associated protein (YAP) -positive angiosarcoma cases. However, survivin expression modes and YAP localization (Hippo pathway activation modes) were not correlated with survival. In addition, we confirmed that survivin small interference RNA (siRNA) transfection and YM155, an anti-survivin drug, elicited decreased nuclear survivin expression and cell proliferation in ISO-HAS-B cells which expressed survivin consistently. Conclusively, these findings support the importance of survivin as a good marker and critical regulator of cellular proliferation for human angiosarcoma and YM155 as a potential therapeutic agent.
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Affiliation(s)
- Masayuki Tsuneki
- Division of Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan.,Division of Pathology, Department of Oral Diagnostic Sciences, School of Dentistry, Showa University, Tokyo, Japan
| | - Takao Kinjo
- Division of Morphological Pathology, Department of Basic Laboratory Sciences, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Taisuke Mori
- Departments of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Yoshida
- Departments of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Kayo Kuyama
- Department of Oral Pathology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Aoi Ohira
- Deparment of Dermatology, University of the Ryukyus, Okinawa, Japan
| | - Takuya Miyagi
- Deparment of Dermatology, University of the Ryukyus, Okinawa, Japan
| | - Kenzo Takahashi
- Deparment of Dermatology, University of the Ryukyus, Okinawa, Japan
| | - Akira Kawai
- Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Chuman
- Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Mikio Masuzawa
- Department of Molecular Diagnostics, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hirofumi Arakawa
- Division of Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan
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15
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Kai Y, Toya R, Saito T, Kuraoka A, Shimohigashi Y, Nakaguchi Y, Maruyama M, Murakami R, Yamashita Y, Oya N. Plan quality and delivery time comparisons between volumetric modulated arc therapy and intensity modulated radiation therapy for scalp angiosarcoma: A planning study. J Med Radiat Sci 2017; 65:39-47. [PMID: 28755441 PMCID: PMC5846018 DOI: 10.1002/jmrs.239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/08/2017] [Accepted: 06/30/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction Due to its spherical surface, scalp angiosarcoma requires careful consideration for radiation therapy planning and dose delivery. Herein, we investigated whether volumetric modulated arc therapy (VMAT) is superior to intensity modulated radiation therapy (IMRT) in terms of the plan quality and delivery time. Methods Three different coplanar treatment plans were created for four patients, comprising a two‐arc VMAT plan as well as 5‐field and 9‐field IMRT plans with 6 MV beams. The X‐ray Voxel Monte Carlo algorithm was employed for dose calculation. A radiation therapy dose of 60 Gy was prescribed to the planning target volume (PTV) in 30 fractions. The homogeneity indexes (HIs) and conformity indexes (CIs) of the PTV, organs at risk (OARs) doses and delivery times were calculated and compared. Results For the VMAT, 5‐field and 9‐field IMRT plans, the mean HIs were 0.14, 0.16 and 0.15; CIs100% were 0.63, 0.61 and 0.64; CIs98% were 0.72, 0.66 and 0.70 and CIs95% were 0.74, 0.67 and 0.71 respectively. All mean dose parameters of the VMAT and 9‐field IMRT plans for the brain were equal to or lower than those of the 5‐field IMRT plan. For the 5‐field IMRT plan, the dose constraints for the left lens were not satisfied in two patients. The mean delivery times were 3.3, 11.1 and 14.7 min for the VMAT, 5‐field and 9‐field IMRT plans respectively. Conclusion The VMAT plan quality is comparable to that of 9‐field IMRT, with a reduced delivery time. Therefore, VMAT represents a valuable, sophisticated irradiation technique for treating scalp angiosarcoma.
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Affiliation(s)
- Yudai Kai
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.,Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Akiko Kuraoka
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | | | - Yuji Nakaguchi
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Masato Maruyama
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryuji Murakami
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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16
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Bernstein JM, Irish JC, Brown DH, Goldstein D, Chung P, Razak ARA, Catton C, Gilbert RW, Gullane PJ, O'Sullivan B. Survival outcomes for cutaneous angiosarcoma of the scalp versus face. Head Neck 2017; 39:1205-1211. [DOI: 10.1002/hed.24747] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/27/2016] [Accepted: 01/03/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jonathan M. Bernstein
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Jonathan C. Irish
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Dale H. Brown
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - David Goldstein
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Peter Chung
- Department of Radiation Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Albiruni R. Abdul Razak
- Department of Medical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Charles Catton
- Department of Radiation Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Ralph W. Gilbert
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Patrick J. Gullane
- Department of Otolaryngology - Head and Neck Surgery / Surgical Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology; University of Toronto, Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
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17
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Sanada T, Nakayama H, Irisawa R, Okubo M, Tsuboi R, Tokuuye K. Clinical outcome and dose volume evaluation in patients who undergo brachytherapy for angiosarcoma of the scalp and face. Mol Clin Oncol 2017; 6:334-340. [PMID: 28451409 PMCID: PMC5403362 DOI: 10.3892/mco.2017.1155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/04/2016] [Indexed: 02/06/2023] Open
Abstract
The present study was conducted to retrospectively evaluate survival and local control with definitive brachytherapy in patients with cutaneous angiosarcoma of the scalp and/or face, and to determine the optimal radiation dose and irradiated volume. Between November, 2009 and January, 2015, 9 consecutive patients with histologically proven angiosarcoma of the scalp and/or face who received image-guided brachytherapy were retrospectively evaluated. The median age of the patients was 83.4 years (range, 67.7-91.9 years). Of the 9 patients, 8 had no lymph node metastasis and 1 patient had cervical lymph node metastasis. The patients were irradiated with a dose of 3 Gy three times per week for varying lengths of time; 4 patients received a total dose of 60 Gy, 1 received 48 Gy and the 4 remaining patients received 45 Gy. The patient who received 48 Gy also underwent additional electron therapy of 16 Gy in 8 fractions. The overall survival, progression-free survival and local progression-free rates at 3 years were 50.8% [95% confidence interval (CI): 15.6-78.1%], 37.0% (95% CI: 6.8-69.3%) and 77.8% (95% CI: 36.5-93.9%), respectively. The local progression-free rate in the 4 patients who received a total of ≥60 Gy was statistically significantly better compared with that in the 5 patients who received a dose of <60 Gy (P=0.027). A total of 7 patients had grade 2 radiation dermatitis, whereas the remaining 2 patients had grade 3 dermatitis. All the patients had grade 2 alopecia. Local disease control achieved by radiotherapy resulted in higher survival. Therefore, prescribing ≥60 Gy in 20 fractions for the gross tumor volume is recommended for angiosarcoma of the scalp and face.
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Affiliation(s)
- Tomohide Sanada
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Hidetsugu Nakayama
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
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18
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Guida M, Campana LG, Curatolo P, Strippoli S, Bonadies A, Grilz G, Cabula C, Rotunno R, Bucher S, Solari N, Santoriello A, Valpione S, Rossi CR. Local treatment with electrochemotherapy of superficial angiosarcomas: Efficacy and safety results from a multi-institutional retrospective study. J Surg Oncol 2016; 114:246-53. [DOI: 10.1002/jso.24287] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Michele Guida
- Medical Oncology Unit; Istituto dei Tumori; Bari Italy
| | - Luca G. Campana
- Veneto Institute of Oncology IOV-IRCCS; Padova Italy
- Department of Surgery, Oncology and Gastroenterology; University of Padova; Italy
| | - Pietro Curatolo
- Department of Dermatology and Plastic Surgery; La Sapienza University; Roma Italy
| | | | - Antonio Bonadies
- Plastic Surgery Unit; San Gallicano Dermatologic Institute IRCCS IFO; Roma Italy
| | - Gretha Grilz
- Breast Surgery Unit; Città della salute e della scienza di Torino; Italy
| | - Carlo Cabula
- Oncologic Surgery; Ospedale Oncologico A. Businco; Cagliari Italy
| | - Roberta Rotunno
- Department of Dermatology and Plastic Surgery; La Sapienza University; Roma Italy
| | - Stefania Bucher
- Plastic Surgery Unit; San Gallicano Dermatologic Institute IRCCS IFO; Roma Italy
| | - Nicola Solari
- Surgical Unit 1; San Martino IST-IRCCS; Genova Italy
| | - Antonio Santoriello
- Dipartimento di chirurgia generale e specialistica II Università di Napoli; Italy
| | - Sara Valpione
- Department of Surgery, Oncology and Gastroenterology; University of Padova; Italy
- Medical Oncology; The Christie NHS Trust; Manchester United Kingdom
| | - Carlo R. Rossi
- Veneto Institute of Oncology IOV-IRCCS; Padova Italy
- Department of Surgery, Oncology and Gastroenterology; University of Padova; Italy
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19
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Uchihara T, Imamura Y, Iwagami S, Kajihara I, Kanemaru H, Karashima R, Ida S, Ishimoto T, Baba Y, Sakamoto Y, Miyamoto Y, Yoshida N, Watanabe M, Iyama KI, Ihn H, Baba H. Small bowel perforation due to indistinguishable metastasis of angiosarcoma: case report and brief literature review. Surg Case Rep 2016; 2:42. [PMID: 27156097 PMCID: PMC4864909 DOI: 10.1186/s40792-016-0169-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/27/2016] [Indexed: 02/06/2023] Open
Abstract
Intestinal metastasis of angiosarcoma is extremely rare. We herein report a case of intestinal perforation due to intestinal metastasis of angiosarcoma. The patient was a 72-year-old Japanese man with multiple recurrent angiosarcomas of the scalp. He developed acute abdominal pain with guarding, and we performed an emergency exploratory laparotomy. An intestinal perforation was found 80 cm from the ligament of Treitz, and partial jejunectomy was successfully performed. Macroscopic inspection revealed no obvious injury, ulcer, or tumor at or around the perforation site. Pathological examination revealed angiosarcoma cells penetrating through all layers of the jejunum at the site of intestinal perforation. This is the first reported case of intestinal perforation caused by indistinguishable intestinal metastasis of angiosarcoma. This case emphasizes intestinal metastasis of angiosarcoma as a possible cause of small bowel perforation in patients with advanced angiosarcoma, even when no visible tumor is present during surgery.
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Affiliation(s)
- Tomoyuki Uchihara
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ikko Kajihara
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hisashi Kanemaru
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryuichi Karashima
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takatsugu Ishimoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Ken-Ichi Iyama
- Department of Surgical Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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20
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Ito T, Uchi H, Nakahara T, Tsuji G, Oda Y, Hagihara A, Furue M. Cutaneous angiosarcoma of the head and face: a single-center analysis of treatment outcomes in 43 patients in Japan. J Cancer Res Clin Oncol 2016; 142:1387-94. [DOI: 10.1007/s00432-016-2151-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 01/07/2023]
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22
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Huntington JT, Jones C, Liebner DA, Chen JL, Pollock RE. Angiosarcoma: A rare malignancy with protean clinical presentations. J Surg Oncol 2015; 111:941-50. [PMID: 26031299 DOI: 10.1002/jso.23918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
Abstract
Angiosarcoma is a rare form of soft tissue sarcoma. Primary small intestinal angiosarcomas are especially uncommon. The clinical presentations of small intestinal angiosarcomas vary but gastrointestinal (GI) bleeding is a frequent finding. We present a case of persistent GI bleeding of unknown etiology culminating in operative exploration demonstrating a primary small intestinal angiosarcoma. A discussion of the diagnosis, pathology, and management of angiosarcoma with a review of the current literature is provided including molecular genetics, difficult cases, and current treatment options.
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Affiliation(s)
- Justin T Huntington
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christian Jones
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David A Liebner
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - James L Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Raphael E Pollock
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center - James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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23
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Recommendations for Therapeutic Decisions of Angiosarcoma of the Scalp and Face. J Craniofac Surg 2015; 26:e253-6. [DOI: 10.1097/scs.0000000000001495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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24
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Fujisawa Y, Yoshino K, Kadono T, Miyagawa T, Nakamura Y, Fujimoto M. Chemoradiotherapy with taxane is superior to conventional surgery and radiotherapy in the management of cutaneous angiosarcoma: a multicentre, retrospective study. Br J Dermatol 2014; 171:1493-500. [DOI: 10.1111/bjd.13110] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Y. Fujisawa
- Department of Dermatology; University of Tsukuba; 1-1-1 Tennodai Tsukuba Ibaraki 305-8575 Japan
| | - K. Yoshino
- Department of Dermatology; Tokyo Metropolitan Cancer and Infectious disease Center Komagome Hospital; Tokyo Japan
| | - T. Kadono
- Department of Dermatology; University of Tokyo; Tokyo Japan
| | - T. Miyagawa
- Department of Dermatology; University of Tokyo; Tokyo Japan
| | - Y. Nakamura
- Department of Dermatology; University of Tsukuba; 1-1-1 Tennodai Tsukuba Ibaraki 305-8575 Japan
| | - M. Fujimoto
- Department of Dermatology; University of Tsukuba; 1-1-1 Tennodai Tsukuba Ibaraki 305-8575 Japan
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Ostheimer C, Janich M, Hübsch P, Gerlach R, Vordermark D. The treatment of extensive scalp lesions using coplanar and non-coplanar photon IMRT: a single institution experience. Radiat Oncol 2014; 9:82. [PMID: 24656070 PMCID: PMC3997930 DOI: 10.1186/1748-717x-9-82] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background This clinical study compared four different cases of extensive scalp malignancies treated by intensity-modulated radiation therapy. The merits of coplanar and non-coplanar Step-and-shoot total scalp irradiation techniques were evaluated against the background of the literature. Methods Four patients (angiosarcoma, n=2, cutaneous B-cell non-Hodgkin lymphoma, B-NHL, n=1, mycosis fungoides, n=1) treated between 2008 and 2012 at our institution were retrospectively analyzed. For every patient with executed coplanar plan, a non-coplanar plan and vice versa has been calculated additionally for direct comparison. Three patients underwent limited surgery before radiotherapy. Individual adapted bolus material was used for every patient (helmet). Total scalp dose was 30 Gy (B-NHL, mycosis fungoides) and 50 Gy (angiosarcoma) with fractional doses of 2.0-2.5 Gy (without sequential local boost in three patients). Conformity and homogeneity indexes and dose volume histograms were used for treatment plan comparison. Results Dose hot spots were higher in coplanar plans (110-128% Dmax). Non-coplanar plans showed a more homogeneous dose distribution (HI = .12 - .17) and superior PTV coverage (88 - 96%). Target dose coverage was 81-117% in non-coplanar and 30-128% in coplanar plans. Coplanar plans yielded a stronger dose gradient across the target (.7-1.6 Gy/mm) compared to non-coplanar plans (.8-1.3 Gy/mm). The most conformal plan was a non-coplanar plan (CI = .7). Mean and maximum brain doses were comparable and showed an almost linear decrease between min. and max. dose. The optic chiasm and brain stem was spared most with non-coplanar plans, mean doses to the lenses ranged between 4 and 8 Gy and were higher in non-coplanar plans as were doses to the optic nerves. Radiotherapy tolerance was acceptable and acute side effects included erythema, scalp pain, alopecia and radiodermatitis which all spontaneously resolved. Two patients accomplished partial response, two patients showed complete response after radiotherapy. Three patients had locally controlled tumors without recurrence until their deaths or at last follow up, one patient had local progression shortly after radiotherapy. Conclusions Photon-IMRT is an effective and feasible approach to treat extensive scalp malignancies. Non-coplanar beams could increase dose homogeneity and PTV coverage and might reduce doses particularly to the optic chiasm.
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Affiliation(s)
- Christian Ostheimer
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg Medical School, Dryanderstrasse 4, Halle 06110, Germany.
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