title: Angiosarcoma of the scalp and face: the Mayo Clinic experience.
abstract: OBJECTIVE
  The etiology and optimal treatment are unknown for angiosarcoma, an aggressive malignant tumor that affects vascular endothelial cells and can be mistaken for benign lesions such as hemangioma.
  
  
  OBJECTIVE
  To determine the treatment outcomes of patients with angiosarcoma of the face or scalp treated with a combination of surgery, radiation therapy, and/or chemotherapy.
  
  
  METHODS
  Retrospective study of 55 patients with angiosarcoma of the face or scalp treated between January 1, 1973, and December 31, 2012, at a tertiary-care academic medical institution.
  
  
  METHODS
  Surgery, radiation therapy, and/or chemotherapy.
  
  
  METHODS
  Locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS).
  
  
  RESULTS
  Fifty-five patients had angiosarcoma localized to the face or scalp. Forty of these patients (73%) received a combination of surgery, radiation therapy, and/or chemotherapy. Eight patients (15%) were treated with surgery alone, 1 (2%) with radiation alone, 5 (9%) with chemotherapy alone, and 1 (2%) with observation alone. Median (range) follow-up for surviving patients was 25.2 (4.7-227.1) months. Five-year LRC, RFS, and OS (95% CI) were 18% (7%-32%), 16% (6%-31%), and 38% (21%-54%), respectively. Of 36 patients with failed treatment, 34 had failure in a local and/or regional site. On univariate analysis, the use of multimodality therapy (vs no multimodality therapy) was associated with higher 5-year LRC (95% CI) (20% [3%-37%] vs 11% [0%-29%]; P = .04), higher RFS (19% [2%-36%] vs 10% [0%-27%]; P = .02), and higher OS (46% [26%-66%] vs 16% [0%-43%]; P = .04). Age 70 years or older (vs <70 years) was associated with lower 5-year LRC (95% CI) (5% [0%-14%] vs 48% [23%-74%]; P = .02) and lower RFS (5% [0%-13%] vs 49% [24%-75%]; P = .04). Radiation therapy (vs no radiation therapy) was associated with higher 5-year LRC (95% CI) (20% [3%-36%] vs 12% [0%-32%]; P = .02) and higher RFS (19% [2%-35%] vs 12% [0%-31%]; P = .004). On multivariable analysis, age younger than 70 years (vs ≥70 years) was associated with improved 5-year LRC (95% CI) (48% [23%-74%] vs 5% [0%-14%]; P = .03) and RFS (49% [24%-75%] vs 49% [24%-75%]; P = .04).
  
  
  CONCLUSIONS
  Multimodality therapy for angiosarcoma is associated with improved LRC, RFS, and OS. Younger patients with resectable disease undergoing multimodality therapy for angiosarcoma had the best clinical outcomes.
authors: Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.
authors: Samir H
authors: SH
authors: Patel
authors: Department of Otolaryngology-Head and Neck Surgery/Audiology, Mayo Clinic Hospital, Phoenix, Arizona.
authors: Richard E
authors: RE
authors: Hayden
authors: Department of Otolaryngology-Head and Neck Surgery/Audiology, Mayo Clinic Hospital, Phoenix, Arizona.
authors: Michael L
authors: ML
authors: Hinni
authors: Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.
authors: William W
authors: WW
authors: Wong
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors: Robert L
authors: RL
authors: Foote
authors: medical student at Midwestern University, Phoenix, Arizona.
authors: Shadi
authors: S
authors: Milani
authors: Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona.
authors: Qing
authors: Q
authors: Wu
authors: Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
authors: Stephen J
authors: SJ
authors: Ko
authors: Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona.
authors: Michele Y
authors: MY
authors: Halyard
mesh_terms: D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005153:Facial Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006394:Hemangiosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012535:Scalp; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome