Outcomes after Definitive Treatment for Cutaneous Angiosarcomas of the Face and Scalp: Re-Evaluating the Role of Combined Modality Treatment

Yoder, Alison; Farooqi, A.; Wernz, C.; Subramaniam, A.; Zheng, J.; Ravi, V.; Goepfert, R.P.; Sturgis, E.M.; Mitra, D.; Bishop, A.J.; Guadagnolo, B.A.

doi:10.1016/j.ijrobp.2022.07.1821

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“…In addition, complete resection is technically difficult if the tumor is too large or there are too many tumors. Although the size and number of tumors were not independent prognostic factors in the present study, they have been shown to affect outcomes [4,7,16,23,28,34]. Therefore, the efficacy of chemotherapy becomes important in the treatment of ASF patients.…”

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confidence: 53%

Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study

Niwa

Tomita

Takaoka

et al. 2023

Cancers

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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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