Outcome of locally recurrent and metastatic angiosarcoma.
BACKGROUND
Angiosarcoma (AS) is a rare soft tissue sarcoma with an enhanced propensity for local and systemic failure. The outcome of locally recurrent and metastatic AS treated at a single institution was evaluated.


METHODS
Medical records of AS patients treated for local recurrence and distant metastasis (1993-2008) were retrospectively reviewed. Univariable and multivariable analyses were performed to identify prognosticators.


RESULTS
Forty-four patients were treated for locally recurrent AS; the majority (59%) were <or=5 cm; the most common sites were skin (48%) and breast (32%). Thirty-two patients (73%) had surgery; 73% received chemotherapy; radiation was delivered to 41%. Median disease-specific survival (DSS) was 50 months [95% confidence interval (CI): 25.7-73.5 months]. Multivariable analysis identified size >5 cm as the only independent adverse prognosticator of recurrent AS-specific survival [hazard ratio (HR): 3.26, P = 0.04]. Ninety-nine patients were treated for metastatic AS; 73% had multiple metastatic sites; the lung was the most common site (36%). Chemotherapy, mainly doxorubicin- and/or paclitaxel-based regimens, were administered to 95 patients (96%). Radiotherapy was utilized in 25% cases; 16% of patients underwent curative-intent surgery. Median DSS was 10 months (95% CI: 7.9-12 months). Isolated lymph node metastasis versus hematogenic spread was the only statistically significant favorable prognostic factor identified (HR: 0.29, P = 0.01).


CONCLUSIONS
Locally recurrent AS is often treatable; complete resection can potentially prolong survival. In contrast, metastatic patients have a grave prognosis; however, patients with isolated lymphatic spread and possibly those treated with taxol-based chemotherapeutic regimens have a favorable outcome.
Lahat
G
G
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Dhuka
A R
AR
Lahat
S
S
Smith
K D
KD
Pollock
R E
RE
Hunt
K K
KK
Ravi
V
V
Lazar
A J
AJ
Lev
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006394:Hemangiosarcoma / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult