title: Outcome of locally recurrent and metastatic angiosarcoma.
abstract: 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.
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: G
authors: G
authors: Lahat
authors: A R
authors: AR
authors: Dhuka
authors: S
authors: S
authors: Lahat
authors: K D
authors: KD
authors: Smith
authors: R E
authors: RE
authors: Pollock
authors: K K
authors: KK
authors: Hunt
authors: V
authors: V
authors: Ravi
authors: A J
authors: AJ
authors: Lazar
authors: D
authors: D
authors: Lev
mesh_terms: 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