Radiation Therapy for Angiosarcoma of the Scalp: Total Scalp Irradiation and Local Irradiation

Hata, Masaharu

doi:10.21873/anticanres.12346

Cited by 25 publications

(39 citation statements)

References 23 publications

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“…Previous studies reported that a total dose of 70 Gy in 35 fractions was typically delivered to patients with angiosarcoma of the scalp that is highly malignant and associated with a very poor prognosis owing to distant metastases at an early stage [ 1 – 5 ]. Accordingly, it is important to reduce the radiation damage to the normal brain tissue occurring because of a higher prescription dose in such cases than in other TSI cases, such as cutaneous lymphoma and squamous cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Angiosarcoma of the scalp is a skin malignancy, which often shows local recurrence [ 1 , 2 ]. Radiation therapy is one of the most important treatment approaches for angiosarcoma of the scalp, and previous studies have reported about local control of this malignancy via total scalp irradiation (TSI) [ 3 – 5 ]. TSI has historically been associated with technical and dosimetric challenges because of the complicated shape of the target region and the close proximity of the scalp to the organs at risk (OARs), such as the brain and eyes.…”

Section: Introductionmentioning

confidence: 99%

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Novel strategy with the automatic non-coplanar volumetric-modulated arc therapy for angiosarcoma of the scalp

et al. 2020

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Background: Total scalp irradiation presents technical and dosimetric challenges. While reports suggest that HyperArc, a new stereotactic radiosurgery planning technique applied to non-coplanar volumetric-modulated arc therapy (VMAT) technique, is associated with high conformity and rapid dose fall-off, the performance of HyperArc for total scalp irradiation has not been explored. The current study aimed to compare the dosimetric performance of HyperArc plans with those of non-coplanar VMAT plans in angiosarcoma of the scalp. Methods: Ten patients with angiosarcoma of the scalp were included in this study. The performance of three different plans administered using TrueBeam Edge were compared: non-coplanar VMAT using flattening filter (FF) beams (VMAT-FF), HyperArc using FF beams (HyperArc-FF), and HyperArc using flattening filter free (FFF) beams (HyperArc-FFF). The dose distribution, dosimetric parameters, and dosimetric accuracy for each of these plans were evaluated. Results: The three plans showed no statistically significant differences in target volume coverage, conformity, and homogeneity. The HyperArc-FF and HyperArc-FFF plans provided significantly lower mean brain doses (12.63 ± 3.31 Gy and 12.71 ± 3.40 Gy) than did the VMAT-FF plans (17.11 ± 5.25 Gy). There were almost no differences in sparing the organs at risk between the HyperArc-FF and HyperArc-FFF plans. The HyperArc-FF and HyperArc-FFF plans provided a shorter beam-on time than did the VMAT-FF plan. The 3%/2 mm gamma test pass rates were above 95% for all three plans. Conclusions: Our results suggest that the HyperArc plan can be potentially used for radiation therapy of target regions with large and complicated shapes, such as the scalp, and that there are no advantages of using FFF beams.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel strategy with the automatic non-coplanar volumetric-modulated arc therapy for angiosarcoma of the scalp

et al. 2020

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“…Involvement of the scalp and calvarium is seen in conditions such as squamous cell carcinoma, angiosarcoma, lymphoma, and melanoma. 9 Infrequently, widespread involvement requires total scalp irradiation. This is more common in adults than in children.…”

Section: Discussionmentioning

confidence: 99%

Scalp and Cranium Radiation Therapy Using Modulation (SCRUM) and Bolus

Low

Lee

Sprow

et al. 2020

Advances in Radiation Oncology

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Purpose A bolus is usually required to ensure radiation dose coverage of extensive superficial tumors of the scalp or skull. Oftentimes, these boluses are challenging to make and are nonreproducible, so an easier method was sought. Methods and Materials Thermoplastic sheets are widely available in radiation oncology clinics and can serve as bolus. Two template cutouts were designed for anterior and posterior halves to encompass the cranium of children and adults. Results The created bolus was imaged using computed tomography, which demonstrated good conformity and minimal air gaps. Conclusions Although making a bolus for treating superficial tumors of the scalp or head and neck is challenging, the presented technique enables thermoplastic to be used as a bolus and is quick, easy, and reproducible.

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“…Pre- or post-operative RT may be used less frequently in these groups, and this may have positively contributed to the LFRS in the population that did not receive RT. Even within high risk histologies, angiosarcomas are consistently shown to be highly malignant with high LR and DR rates and often receive RT as part of their treatment plan [15-17]. Our population contained a high percentage of angiosarcomas as compared to other STS sites [15].…”

Section: Discussionmentioning

confidence: 99%

“…Even within high risk histologies, angiosarcomas are consistently shown to be highly malignant with high LR and DR rates and often receive RT as part of their treatment plan [15-17]. Our population contained a high percentage of angiosarcomas as compared to other STS sites [15]. Thus, it is likely that our RT cohort included more malignant histologies and higher grade disease.…”

Section: Discussionmentioning

confidence: 99%

Local Relapse and Survival Outcomes in Patients with Scalp Sarcoma: A Retrospective Study of 95 Patients Treated in a Provincial Cancer Care Institution Over 25 Years

Jasper

Holloway

DeVries

et al. 2019

Cureus

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ObjectivesThere is limited literature on the optimal treatment of sarcoma arising in the scalp. This study evaluates local relapse (LR) and survival outcomes of patients with scalp sarcoma treated at a provincial cancer care institution.MethodsA retrospective review of 95 patients with a primary diagnosis of scalp sarcoma referred from 1990-2015 was completed. Kaplan-Meier statistics were used to estimate LR-free survival (LRFS) and overall survival (OS). Survival curves were compared using log-rank tests. Regression analyses were performed using Cox proportional hazards model.ResultsThe median age at diagnosis was 77 years. The most common histologies were angiosarcoma (27%), undifferentiated pleomorphic sarcoma (24%), and pleomorphic dermal sarcoma (21%). Final margins were 36% positive, 28% close, 31% negative, and 5% unknown. Of 73 patients treated with curative-intent, 32 (44%) experienced LR. Five-year LRFS was 56.0% and overall survival was 48.3%. Patients with close or positive margins who received pre- or post-operative radiotherapy (n=19) had similar LR risk compared to patients who did not (n=34) (five-year LRFS 41.8% vs 69.1%; p=0.145). On multivariate analysis, angiosarcoma was associated with a higher LR risk (Hazard ratio (HR) 12.06, p<0.001). The use of radiotherapy showed a trend towards reduced LR risk but did not reach statistical significance (HR 0.37, p=0.066).ConclusionsPatients with scalp sarcoma have high risk of LR, particularly in cases with positive margins. Adjuvant radiation was not associated with improved local control for close or positive margins. Complete surgical excision to establish negative margins remains the primary standard treatment for patients with this rare disease.

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Radiation Therapy for Angiosarcoma of the Scalp: Total Scalp Irradiation and Local Irradiation

Abstract: Abstract. Angiosarcoma, a rare cutaneous malignancy,

Cited by 25 publications

References 23 publications

Novel strategy with the automatic non-coplanar volumetric-modulated arc therapy for angiosarcoma of the scalp

Novel strategy with the automatic non-coplanar volumetric-modulated arc therapy for angiosarcoma of the scalp

Scalp and Cranium Radiation Therapy Using Modulation (SCRUM) and Bolus

Local Relapse and Survival Outcomes in Patients with Scalp Sarcoma: A Retrospective Study of 95 Patients Treated in a Provincial Cancer Care Institution Over 25 Years

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