A prognostic model for resectable soft tissue and cutaneous angiosarcoma

Sinnamon, Andrew J.; Neuwirth, Madalyn G.; McMillan, Matthew T.; Ecker, Brett L.; Bartlett, Edmund K.; Zhang, Paul J.; Kelz, Rachel R.; Fraker, Douglas L.; Roses, Robert E.; Karakousis, Giorgos C.

doi:10.1002/jso.24352

Cited by 51 publications

(66 citation statements)

References 24 publications

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“…In the study from Japan of 260 cases of CAS, the 5-year overall survival among patients who could receive surgery was <20% ( 49 ) (median overall survival: < 20 months), whereas in the studies from western countries, it was 31–51% ( 5 , 11 , 25 , 31 , 40 ). CAS patients in Japan had equivalent survival to the “high risk” group reported by Sinnamon et al ( 32 ), with a median overall survival of 1.6 years. This difference might be explained by the fact that the tumor size in Japanese patients is generally large: in the study of 260 CAS cases, 44% of the patients had tumors of at least 10 cm (originally, described as tumors larger than 100 cm 2 ) ( 49 ), whereas tumors larger than 5 cm (T2) constituted only 18–38% of the patients in the studies from western countries ( 5 , 11 , 25 , 40 ).…”

Section: Prognosis and Factors Associated With Survivalmentioning

confidence: 60%

“…Generally, soft-tissue sarcomas have a 50–60% survival rate ( 30 ), whereas the 5-year survival rate for angiosarcoma is <40% ( 12 , 25 , 31 , 32 ). Several factors are reportedly associated with poor survival: older age ( 25 , 32 ), worse performance status ( 33 , 34 ), larger tumor size ( 5 , 8 , 20 , 32 , 35 – 40 ), positive margin status ( 31 , 32 , 38 , 41 , 42 ), higher histologic type or grade ( 32 , 37 , 41 , 43 , 44 ), scalp as the primary location ( 5 , 36 , 45 ), deeper location of the tumor ( 20 , 31 ), and presence of distant metastasis ( 33 , 38 , 41 , 46 ). On the other hand, the following factors were associated with favorable prognosis: surgery ( 20 , 34 ), multimodal therapy ( 5 , 39 , 41 ) and postoperative radiotherapy ( 34 , 36 , 41 , 43 , 47 , 48 ).…”

Section: Prognosis and Factors Associated With Survivalmentioning

confidence: 99%

“…A study by Sinnamon et al ( 32 ) of 821 angiosarcomas included 211 cases of primary CAS in the head and neck. In their cohort, all cases of metastatic disease were excluded and all the patients received surgical treatment.…”

Section: Prognosis and Factors Associated With Survivalmentioning

confidence: 99%

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Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor

et al. 2018

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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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Section: Prognosis and Factors Associated With Survivalmentioning

confidence: 60%

Section: Prognosis and Factors Associated With Survivalmentioning

confidence: 99%

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Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor

et al. 2018

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“…In their meta-analysis, Shin et al [ 14 ▪▪ ] found that surgery improves the 5-year survival rate compared with other treatments [odds ratio (OR) = 4.369; P = .002]. Sinnamon et al [ 16 ] found that positive resection margins are associated with worse overall survival (OS). Curative surgery should always be considered for patients with cAS.…”

Section: Prognosis and Management Of The Diseasementioning

confidence: 99%

Cutaneous angiosarcoma: update on biology and latest treatment

Ishida

Otsuka

Kabashima

2018

Current Opinion in Oncology

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Purpose of reviewThe present review aims to provide readers with the latest updates on the biology and clinical management of cutaneous angiosarcoma (cAS).Recent findingsThe genomic alteration of cAS is heterogeneous. Mutations are enriched in the mitosis-activated kinase (MAPK) pathway. Functional analysis has identified molecules that may serve as potential markers and therapeutic targets of angiosarcoma. These molecules include survivin, HSP90, FOXM1, miR-497-5p, KCa3.1, and miR210.This body of knowledge has not yet transferred to clinical practice. The mainstay of treatment for cAS remains surgery followed by postoperative radiotherapy. The efficacy of paclitaxel as an adjuvant chemotherapy is suggested.For patients with advanced cAS, paclitaxel is the treatment of choice. There are also second-line treatment options that are supported by evidence of varying strength. A multikinase inhibitor, pazopanib, has been assessed in several studies, most of which support its efficacy for angiosarcoma. Bevacizumab monotherapy may be effective for angiosarcoma. The efficacy of eribulin mesylate and trabectedin for angiosarcoma is currently being assessed. Recent publications highlighted the role of the immune system in the biology of cAS.SummaryFuture research efforts should focus on the following aspects of cAS: drug development directed at recent molecular targets, clinical trials designed specifically for patients with cAS, and the role of immunotherapy for cAS.

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“…A study performed at the University of Texas MD Anderson Cancer Center demonstrated that patients who undergo combination therapy have statistically greater overall survival compared with those who undergo radiation or surgery alone 97. Histopathologically clear surgical margins are of paramount importance and correlate with better outcome 100. Although no clear guidelines exist on the specific width of surgical margins in cAS, achievement of 3 cm or greater clear margins as well as deep margins is recommended 5…”

Section: Current Treatment Recommendations and Undergoing Clinical Trmentioning

confidence: 99%

Cutaneous angiosarcoma: a current update

et al. 2017

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Cutaneous angiosarcoma (cAS) is a rare malignant neoplasm with variable clinical presentation. Although a distinct vascular tumour, cAS shares many overlapping histopathological features with other vasoformative and epithelioid tumours or 'mimickers'. cAS shows aggressive behaviour and carries a grave prognosis, thus early diagnosis is of paramount importance to achieve the best possible outcomes. Recently, several genetic studies were conducted leading to the identification of novel molecular targets in the treatment of cAS. Herein, we present a comprehensive review of cAS with discussion of its clinical, histopathological and molecular aspects, the differential diagnosis, as well as current therapies including ongoing clinical trials.

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A prognostic model for resectable soft tissue and cutaneous angiosarcoma

Cited by 51 publications

References 24 publications

Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor

Cutaneous Angiosarcoma: The Possibility of New Treatment Options Especially for Patients with Large Primary Tumor

Cutaneous angiosarcoma: update on biology and latest treatment

Cutaneous angiosarcoma: a current update

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