Radiation Therapy in the Treatment of Cutaneous Angiosarcoma of the Head and Neck
Daniel Spratt, Elizabeth Gordon-Spratt, Jonathan Romanyshyn, Suzanne Wolden, Snehal Patel, Jatin Shah, Ashok Shaha, David Pfister, Mary Keohan and Nancy Lee
World Journal of Surgical Medical and Radiation Oncology 2013, 2:2
Cutaneous angiosarcoma is an aggressive vascular tumor constituting <0.1% of head and neck malignancies. Due to its rarity, little is known about the role of radiation therapy.
Retrospective review from 1991 - 2011 of 24 patients with histologically - proven cutaneous angiosarcoma of the head and neck treated with radiation therapy at a single institution with curative intent.
Materials and Methods
Fourteen patients were treated with definitive radiotherapy alone, and 10 patients underwent surgical resection followed by adjuvant post-operative radiotherapy. Overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and toxicity data were assessed. Kaplan-Meier method, cox-regression, and competing risk analyses were performed to assess outcomes.
With a median follow-up of 25.1 months, survival outcomes were not significantly different between patients treated with post-operative radiotherapy or radiotherapy alone. For the entire cohort, the three-year OS was 36%, LRFS was 40%, and DMFS was 53%, and was not significantly different between groups (p=0.26, p=0.34, p=0.19, respectively). Patients experiencing acute grade 2, 3, and 4 toxicity occurred in 7, 7, and 2 patients, respectively.
Despite improvements in chemotherapy, biological agents, surgical and radiotherapy techniques, outcomes for cutaneous angiosarcoma remain poor and further research is warranted. Based on our results in patients treated with definitive radiotherapy, our data show that definitive radiotherapy is safe with acceptable efficacy and should be considered for unresectable tumors, or when resection would result in an unacceptable cosmetic defect or significant morbidity.