Radiation Therapy for Angiosarcoma

Scott, Michael; Portnow, Leah H.; Morris, Christopher G.; Marcus, Robert B.; Mendenhall, Nancy P.; Mendenhall, William M.; Indelicato, Daniel J.

doi:10.1097/coc.0b013e3182436ea3

Cited by 37 publications

(14 citation statements)

References 27 publications

(95 reference statements)

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“…Given the poor local control with surgery alone, Scott et al reported the University of Florida experience of using hyperfractionated radiation therapy with hyperthermia for treatment of 41 angiosarcoma patients, including 16 RAA cases, and involving a variety of sites. In this series, aggressive treatment with resection and hyperfractionated radiotherapy was associated with the best prognosis [29]. Various taxane-based chemotherapeutic regimens have also shown some benefit, both in the neoadjuvant and unresectable setting.…”

Section: Discussionmentioning

confidence: 99%

Sporadic versus Radiation-Associated Angiosarcoma: A Comparative Clinicopathologic and Molecular Analysis of 48 Cases

Hung

Hiniker

Lucas

et al. 2013

Sarcoma

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Angiosarcomas are aggressive tumors of vascular endothelial origin, occurring sporadically or in association with prior radiotherapy. We compared clinicopathologic and biologic features of sporadic angiosarcomas (SA) and radiation-associated angiosarcomas (RAA). Methods. From a University of Michigan institutional database, 37 SA and 11 RAA were identified. Tissue microarrays were stained for p53, Ki-67, and hTERT. DNA was evaluated for TP53 and ATM mutations. Results. Mean latency between radiotherapy and diagnosis of RAA was 11.9 years: 6.7 years for breast RAA versus 20.9 years for nonbreast RAA (P = 0.148). Survival after diagnosis did not significantly differ between SA and RAA (P = 0.590). Patients with nonbreast RAA had shorter overall survival than patients with breast RAA (P = 0.03). The majority of SA (86.5%) and RAA (77.8%) were classified as high-grade sarcomas (P = 0.609). RAA were more likely to have well-defined vasoformative areas (55.6% versus 27%, P = 0.127). Most breast SA were parenchymal in origin (80%), while most breast RAA were cutaneous in origin (80%). TMA analysis showed p53 overexpression in 25.7% of SA and 0% RAA, high Ki-67 in 35.3% of SA and 44.4% RAA, and hTERT expression in 100% of SA and RAA. TP53 mutations were detected in 13.5% of SA and 11.1% RAA. ATM mutations were not detected in either SA or RAA. Conclusions. SA and RAA are similar in histology, immunohistochemical markers, and DNA mutation profiles and share similar prognosis. Breast RAA have a shorter latency period compared to nonbreast RAA and a significantly longer survival.

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Section: Discussionmentioning

confidence: 99%

Sporadic versus Radiation-Associated Angiosarcoma: A Comparative Clinicopathologic and Molecular Analysis of 48 Cases

Hung

Hiniker

Lucas

et al. 2013

Sarcoma

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“…100 ANGIOSARCOMA MANAGEMENT By and large, angiosarcomas have a poor prognosis with reported 5-year survival rates ranging from 12% to 35%. 101 Treatment options include surgery, radiotherapy and chemotherapy, but outcomes vary widely and are impacted by site, size, resectability and tumour type (i.e. de novo vs radiation induced).…”

Section: Angiosarcoma Metastasesmentioning

confidence: 99%

“…de novo vs radiation induced). 101 Angiosarcomas of the scalp, compared with other sites, have a particularly poor prognosis with significant reduction in overall survival. Although angiosarcomas secondary to prior radiation have improved outcomes in some studies, other research contradict this finding.…”

Section: Angiosarcoma Metastasesmentioning

confidence: 99%

Angiosarcoma: clinical and imaging features from head to toe

Gaballah

Jensen

Palmquist

et al. 2017

The British Journal of Radiology

167

168

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Angiosarcoma is a rare, aggressive subtype of soft-tissue sarcoma with a propensity for local recurrence and metastasis associated with a generally poor prognosis, unless diagnosed early. Given the vascular endothelial cell origin of angiosarcoma, tumours may develop in essentially any organ; however, there is a predilection for the skin where half of all tumours arise, increasing in prevalence with age. The most common risk factors are chronic lymphoedema and history of radiation. We review the most important radiological findings along the spectrum of angiosarcoma from head to toe throughout the body, including uncommon and rare locations. Key imaging features of angiosarcoma across multiple organ systems will be described, as well as the impact on management and prognosis.

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“…On the other hand, Ogawa et al ( 34 ) reported that in their cohort of 25 patients who received radiation monotherapy with curative intent, 11 of the 14 patients (79%) who received >70Gy achieved local control, whereas only 3 of the 11 patients (27%) who received <70 Gy did. A study by Scott et al ( 81 ) of 41 patients treated with radiation recommended at least 60–65 Gy for the postoperative tumor bed and 70–75 Gy for patients who receive radiation monotherapy. Others ( 82 ) suggested that improved delivery of radiation might achieve higher efficacy.…”

Section: Treatmentmentioning

confidence: 99%

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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Radiation Therapy for Angiosarcoma

Abstract: For angiosarcomas treated with radiotherapy, outcome varies widely and is impacted by tumor site, size, and resectability. In amenable sites, aggressive treatment with resection and hyperfractionated radiotherapy may offer the best prognosis.

Cited by 37 publications

References 27 publications

Sporadic versus Radiation-Associated Angiosarcoma: A Comparative Clinicopathologic and Molecular Analysis of 48 Cases

Sporadic versus Radiation-Associated Angiosarcoma: A Comparative Clinicopathologic and Molecular Analysis of 48 Cases

Angiosarcoma: clinical and imaging features from head to toe

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

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