The Effectiveness of Different Treatment Modalities of Cutaneous Angiosarcoma: Results From Meta-Analysis and Observational Data From SEER Database

A Clinicopathologic Feature and Survival Analysis of Cutaneous Angiosarcoma: A Single Tertiary Center Study

BACKGROUND

Cutaneous angiosarcoma, a rare malignant tumor, is associated with high mortality and poor prognosis.

OBJECTIVE

This study aimed to analyze the clinicopathologic features of cutaneous angiosarcoma and identify the prognostic factors influencing survival.

METHODS

Medical records of patients diagnosed with cutaneous angiosarcoma between January 1995 and March 2023 were retrospectively reviewed. Demographic data, clinicopathologic features, and treatment modalities were analyzed to evaluate the correlation with overall survival (OS) and progression-free survival (PFS). A total of 70 patients were included in the study.

RESULTS

Their mean age at diagnosis was 71 years (range, 41-91 years). Of them, 57 (81.4%) were males. Five-year OS and PFS rates were 29.0% and 10.7%, respectively. In univariate analysis, a mass in the frontal area of the scalp showed significant associations with poorer PFS (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.07-3.55; p=0.029) and poorer OS (HR, 2.42; 95% CI, 1.22-4.80; p=0.011). Mass size exceeding 3 cm had a notable impact on PFS (HR, 3.41; 95% CI, 1.32-8.82; p=0.011) and remained a significant independent adverse prognosticator in multivariate analysis (HR, 4.55; 95% CI, 1.22-16.99; p=0.024).

CONCLUSION

Cutaneous angiosarcoma is characterized by an unfavorable prognosis, with a larger mass size identified as an independent prognostic factor.

Genomic landscape and preclinical models of angiosarcoma

Angiosarcoma is a cancer that develops in blood or lymphatic vessels that presents a significant clinical challenge due to its rarity and aggressive features. Clinical outcomes have not improved in decades, highlighting a need for innovative therapeutic strategies to treat the disease. Genetically, angiosarcomas exhibit high heterogeneity and complexity with many recurrent mutations. However, recent studies have identified some common features within anatomic and molecular subgroups. To identify potential therapeutic vulnerabilities, it is essential to understand and integrate the mutational landscape of angiosarcoma with the models that exist to study the disease. In this review, we will summarize the insights gained from reported genomic alterations in molecular and anatomic subtypes of angiosarcoma, discuss several potential actionable targets, and highlight the preclinical disease models available in the field.

Novel Detection and Clinical Utility of Serum-Derived Extracellular Vesicle in Angiosarcoma

Cutaneous angiosarcoma is a rare and highly aggressive skin malignancy. The aim of this study is to explore the alteration of serum-derived extracellular vesicle (EV) in angiosarcoma patients and to evaluate its clinical utility as a novel circulating biomarker. In a microarray analysis to examine the differential expression of specific EV-associated microRNAs in sera between cutaneous angiosarcoma patients and healthy controls, 73 microRNAs with significant upregulation and 100 microRNAs with significant downregulation, respectively, were identified in patients with angio-sarcoma. Among them, quantitative PCR confirmed that miR-184, miR-3925-5p, miR-3926, and miR-5703 were upregulated in sera of cutaneous angiosarcoma patients compared with those of healthy controls and melanoma patients. Additionally, these 4 microRNAs were expressed more highly in angiosarcoma cell lines compared with normal human endothelial cell lines and were prone to elevate along with disease progression. Furthermore, a gene analysis predicted that the target gene set of microRNAs might affect the regulation of TP53 via the epigenetic regulation of MECP2. Taken together, these 4 extracellular vesicle-associated microRNAs in circulation serve as a promising liquid biomarker to identify angiosarcoma patients and trace disease progression.

Improving the effectiveness of SUD treatment through a national registry

CONTEXT

Recent research into the effectiveness of abstinence-based substance use disorder (SUD) treatment indicates that there has not been a substantial improvement since the Drug Abuse Treatment Outcome Study research in 1993. Research into medication-supported treatments for SUD are hindered by a dearth of real-world longitudinal outcome studies. Patient registries have dramatically improved survival rates in many diseases by providing researchers with longitudinal data on a broad spectrum of patients undergoing a variety of treatments. Policy prescription: We recommend the creation of a national registry for patients receiving treatment for SUD akin to the Surveillance, Epidemiology, and End Results Program established in 1971 to track cancer patient outcomes. One option would be to expand the data currently being collected in the Treatment Episode Data Set (TEDS) to include all nonpublicly funded treatment and to allow for longitudinal tracking of deidentified individuals. Information on medication use and deaths could be kept up to date through integrations with state-wide death registries and Prescription Drug Monitoring Programs. The TEDS dataset already undergoes extensive data deidentification to make sure individuals cannot be identified prior to releasing the admissions and discharge datasets to researchers. Once longitudinal tracking is available, even more stringent deidentification will be necessary, and access to the dataset would be restricted to public health researchers.

CONCLUSION

The development of a registry of individuals undergoing treatment for SUD can be expected to enhance our understanding of the progression of the disease and the relative effectiveness of different treatment modalities for patients with different drug use histories and characteristics.

Contemporary diagnostic approach to atypical vascular lesion and angiosarcoma

Vascular neoplasms account for a substantial fraction of cutaneous mesenchymal tumors, spanning from clinically indolent benign lesions to highly aggressive malignancies. These neoplasms present a distinctive challenge in terms of their diagnostic histopathology, both because of the breadth of their morphological manifestations and because of the significant histological overlap between different entities, even benign and malignant ones. The post-radiotherapy setting is particularly problematic diagnostically, insofar as radiation exposure predisposes not only to secondary angiosarcoma, but also to atypical vascular lesion, a largely benign proliferation of cutaneous blood vessels typically affecting the breast. To address these challenges, we explore the clinical, histological, and molecular features of malignant vascular neoplasia, including primary and secondary subtypes, through the comparative lens of atypical vascular lesion. In addition to highlighting the key morphological indicators of malignancy in superficial vasoformative tumors, we offer an approach that integrates clinical characteristics and molecular genetic profiling to facilitate accurate classification. With this current knowledge as our foundation, we also look ahead in an effort to frame some of the key unanswered questions regarding superficial vascular malignancies and their natural history, clinical management, and molecular underpinnings.

When Radiation Therapy Becomes a Foe: A Rare Case of Radiation-Induced Angiosarcoma of Head and Neck

Angiosarcomas are a rare subtype of sarcomas originating from vascular endothelial cells. Though frequently found in the head and neck area, there are minimal reports of radiation-induced angiosarcomas in this area. They have a poor prognosis due to a high rate of lymph node metastasis and, hence, require to be addressed promptly in order to improve survival. We present a rare case of radiation-induced angiosarcoma in a patient previously irradiated for squamous cell carcinoma of the neck. Due to variable and complex patient presentations of the disease, this case will help raise awareness of an uncommon complication of a common treatment offered to patients.

Angiosarcomas of the head and neck: Impact of large data analysis on clinical management

Angiosarcoma is a rare but often fatal malignancy from blood and lymphatic vessels that can arise anywhere in the body and often affects the head and neck region. Although its dismal prognosis is predominantly explained by its aggressive biology, several secondary factors contribute to poor outcomes. These include a phenotypic resemblance to innocuous blood vessel lesions, which contributes to a significant degree of late diagnosis. Another important factor is the rarity of angiosarcoma, which has impaired scientific determination of its optimal treatment significantly. As a result, treatment of angiosarcomas has largely been guided by information derived from the study of sarcomas at large, themselves a highly heterogeneous group of mesenchymal cancers both from a diagnostic as well as therapeutical perspective. The Digital Revolution and resultant Information Age promise to focus the clinical management of rare cancers from a generic to a more customized approach. In this paper, we review the current understanding of head and neck angiosarcomas within the context of this process.

Cutaneous Angiosarcoma of the Head and Neck-A Retrospective Analysis of 47 Patients

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.

Chemotherapy in patients with localized angiosarcoma of any site: A retrospective european study

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.

Management of Cutaneous Angiosarcoma: an Update Review

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.

Malignant Vascular Tumors of the Head and Neck-Which Type of Therapy Works Best?

Simple Summary

Malignant vascular tumors are extremely rare tumors with variable clinical courses, and few data on their clinical management are available. Diagnosis is difficult due to their wide morphologic appearance. The intent of the present review is to demonstrate the current knowledge and management on malignant vascular tumors of the head and neck area. The mainstay of treatment for malignant vascular tumors is surgery, but radiotherapy and chemotherapy are also parts of the treatment concept especially in angiosarcomas. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options.

Abstract

Malignant vascular tumors of the head and neck are rare neoplasms with variable clinical presentation, wide age distribution, and variable clinical courses. The heterogeneous presentation of angiosarcomas and epithelioid hemangioendothelioma often leads to misdiagnosis and unsuitable treatment. While risk factors for angiosarcomas are previous radiation, chronic lymphedema, and exposure to arsenic, thorium oxide, or vinyl chloride, there are only limited and retrospective data available on prognostic factors in EHE. In both angiosarcomas and EHE, surgery is the mainstay of treatment. There is limited evidence regarding the role of radiotherapy in EHE, although EHE is considered relatively radiosensitive. In angiosarcomas, adjuvant radiotherapy is recommended according to retrospective case series. A standard medical therapy for metastasized malignant vascular tumors is lacking. Chemotherapy, which is effective in angiosarcoma, is mostly ineffective in EHE. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. The goal of this review is to summarize the current data regarding malignant vascular tumors along with their diagnosis and management.

Computed tomography features of pulmonary metastases from angiosarcoma: Lessons learned from one case study

A distinctive feature of some angiosarcomas is that two or more atypical forms of pulmonary metastases may be detected concomitantly. In this case report, we present a 37-year-old man diagnosed with angiosarcoma of the neck, with extreme diversity of lung metastases on chest computed tomography (CT). We analyzed CT features of metastases and discussed possible reasons for their pleomorphism, as well as clinical implications of these findings.