title: Experience of angiosarcoma in the North of England Bone and Soft Tissue Tumour Service.
abstract: BACKGROUND
  Angiosarcomas are rare aggressive sarcomas of vascular endothelial origin. These tumours have the potential to be multicentric and are associated with high rates of local recurrence, which makes treatment challenging. The gold-standard is that these patients are managed in specialist centres by a multidisciplinary team. We present our experience of managing patients with angiosarcoma in the North of England Bone and Soft Tissue Tumour Service and a review of the literature.
  
  
  METHODS
  A prospectively collated electronic database was used to identify patients with angiosarcoma treated between 2000 and 2008, and an analysis performed of demographics, anatomical site, surgical excision and reconstruction, local disease recurrence and metastatic disease.
  
  
  RESULTS
  Fifteen patients (ten female, five male, mean age 71 years) were identified. Eight patients developed tumours in a previously irradiated area, after a mean of 11 years. Six patients had metastatic disease at presentation. Fourteen patients underwent wide surgical excision of the tumour, of which nine required defect reconstruction (five free latissimus dorsi flaps, two free anterolateral thigh flaps, two pedicled latissimus dorsi flaps). One patient was treated with chemotherapy only. Five of 14 patients received adjuvant radiotherapy, and one received adjuvant chemotherapy. Two out of 14 patients developed local recurrence. Eight patients developed metastases, the majority of which were pulmonary. Estimated five-year survival was calculated as 33% in our patient cohort.
  
  
  CONCLUSIONS
  Angiosarcomas are aggressive, difficult to treat tumours, which can occur secondary to a multitude of causes. Clinical suspicion, biopsy and early diagnosis are essential to allow optimum treatment, which currently consists of radical surgery, together with adjuvant radiotherapy and chemotherapy.
authors.affiliation: Department of Plastic Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne, NE1 4LP, UK. drchristopherlewis@googlemail.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Lewis
authors.forename: C
authors.initials: C
authors.lastname: Gerrand
authors.forename: D E
authors.initials: DE
authors.lastname: Barnes
authors.forename: S
authors.initials: S
authors.lastname: Murray
authors.forename: R H
authors.initials: RH
authors.lastname: Milner
authors.forename: M
authors.initials: M
authors.lastname: Ragbir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006394:Hemangiosarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D016522:Oncology Service, Hospital; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom