Cutaneous Angiosarcoma: A Single-Institution Experience

Abstract

Background Cutaneous angiosarcoma (CAS) is a rare, aggressive vascular sarcoma with a poor prognosis, historically associated with 5-year overall survival (OS) rates between 10 and 30 %. Methods This is a single-institution retrospective review of patients treated for CAS from 1999–2011. Demographics, primary tumor characteristics, treatment, and outcomes were analyzed. Results A total of 88 patients were identified (median age 70 years and 57 % female). Median tumor size was 3 cm. Median follow-up was 22 months. The 5-year OS and recurrence-free survival (RFS) were 35.2 and 32.3 %, respectively; median was 22.1 months. Also, 36 patients (41 %) received surgery alone, 7 (8 %) received XRT alone, and 41 (47 %) received surgery and XRT. Of the 67 of 88 patients who were disease-free after treatment, 33 (50 %) recurred (median of 12.3 months). Surgery alone had the highest 5-year OS (46.9 %) and RFS (39.9 %) (p = ns). Four presentation groups were identified: (1) XRT induced, n = 30 (34 %), 26 of 30 occurred in females with a prior breast cancer, (2) sporadic CAS on head and neck (H/N), n = 38, (3) sporadic CAS on trunk/extremities, n = 13, and (4) Stewart–Treves n = 7. Those with trunk/extremity CAS had the highest 5-year OS (64.8 %), with H/N CAS having the worst 5-year OS (21.5 %). On MV analysis, only tumor size <5 cm correlated with improved OS (p = 0.014). Discussion In this large series, there appears to be a better overall prognosis than historically reported, especially in Stewart–Treves and CAS on trunk or extremities. While surgery alone was associated with better OS and RFS compared with other treatment modalities, this was not statistically significant. Tumor size was a significant prognostic factor for OS.

Surgical treatment associated with improved survival in patients with cutaneous angiosarcoma

“…Contrary to previously published single-institutional reports and review studies, [3][4][5] we did not find any evidence to suggest that RT or CT had any independent survival benefit. We have also found surgery to be associated with significant survival benefit.…”

“…1,3 Due to low incidence rates, the clinical outcome data have been limited to case reports and single institution studies, with a lack of direct comparison between various treatment modalities: surgery, RT and chemotherapy (CT). 4,5 In this study, we aimed to investigate the impact of undergoing different therapeutic approaches on long-term overall survival (OS) using cross-institutional data. The National Cancer Database (NCDB), a joint project of the American Cancer Society (ACS) and the Commission on Cancer (CoC) that currently captures over 70% of all newly diagnosed malignancies in the United States yearly, was queried for patients diagnosed with cutaneous angiosarcoma from 2004 to 2012.…”

Infiltration of PD-1-positive cells in combination with tumor site PD-L1 expression is a positive prognostic factor in cutaneous angiosarcoma

“…[5][6][7] Patients' prognosis, however, remains poor with a 5-y survival of approximately 10% to 20% due to the eventual formation of distant metastases. [8][9][10] The development of more effective treatments is therefore required, and immunotherapy could be a therapeutic option. Fujii et al reported that antitumor immunity with CD8 C T cells in tumor-infiltrating lymphocytes (TILs) is important to prevent the progression of CAS.…”

Treatment of cutaneous angiosarcoma of the scalp and face in the Chinese patients: local experience at a regional hospital in Hong Kong

“…The 5-year overall survival (OS) has been variously reported as 24% to 35%. 1,2 When radiotherapy (RT) is given as the main treatment, median survival is only 8 months. 3 Almost half (43%) of angiosarcomas originate from the skin of the head and neck.…”

“…3 Almost half (43%) of angiosarcomas originate from the skin of the head and neck. 1,2 Compared with truncal and extremity angiosarcoma, the prognosis of cutaneous angiosarcoma (CAS) of the head and neck is even worse. Perez et al 2 indicated a greater need for flap or graft reconstruction after tumour extirpation for head and neck CAS (HNCAS), a ORIGINAL ARTICLE was 7.5 months.…”