Clinical significance of local control of primary tumour in definitive radiotherapy for scalp angiosarcomas
Tairo KashiharaDai OgataKae OkumaSatoshi NakamuraHiroki NakayamaTaisuke MoriAkira TakahashiKenjiro NamikawaAyaka TakahashiKana TakahashiTomoya KanedaKoji InabaNaoya MurakamiHiroyuki OkamotoYuko NakayamaNaoya YamazakiHiroshi Igaki
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Abstract:
Scalp angiosarcoma is a rare and aggressive cancer. Definitive radiotherapy is a treatment option for localised scalp angiosarcoma patients. Although definitive surgical resection reportedly prolongs overall survival (OS), whether initial local treatment effect affects OS when definitive radiotherapy is administered is unclear. Therefore, this study analysed whether local recurrence within 6 months of irradiation correlates with OS and cancer-specific survival (CSS). Furthermore, how local control affects patients' quality of life was investigated.Thirty-one localised scalp angiosarcoma patients who had received definitive radiotherapy at our institution between October 2010 and July 2021 were analysed retrospectively. The most commonly used dose fractionation was 70 Gy in 35 fractions (83.9%). Local recurrence within 6 months of radiotherapy and other clinical factors were examined in univariate and subsequent multivariate analyses for correlation with OS and CSS.The median follow-up period was 16 months (range, 6-45 months). Local recurrence was detected in 16 patients (51.6%), 12 of whom had recurrence within 6 months. In multivariate analyses, the presence of local recurrence within 6 months of radiotherapy was significantly associated with OS and CSS (p = 0.003, 0.0001, respectively). Ten of the 16 patients with local recurrence had severe symptoms such as bleeding, pain, difficulty opening the eye and malodour.The initial local treatment effect was significantly associated with OS and CSS after definitive radiotherapy. Furthermore, local recurrence after radiotherapy resulted in a variety of symptoms, including bleeding and pain, which reduced the patient's quality of life.Keywords:
Univariate analysis
ÖZETTüm skalp ışınlaması (TSI) yaygın skalp tutulumu yapabilen tümöre sahip hastalarda sıklıkla palyatif amaçlı kullanılmaktadır.Tüm skalpte tedavi edici dozun homojen bir şekilde dağılımı ile birlikte beyin ve diğer risk altındaki organların korunabilmesi TSI'ın hem planlanma hem de uygulamasındaki önemli teknik zorluklardır.Yıllar içerisinde tedavi modalitelerindeki teknolojik gelişmeler doğrultusunda TSI'nda farklı teknikler tanımlanmıştır.Fakat üst teknolojilere sahip olmayan tedavi merkezleri için çok fazla farklı seçenek bulunmamaktadır.Bu makalemizde yaygın skalp tutulumu olan 88 yaşında anjiyosarkom tanılı erkek hastamıza palyatif amaçlı (45 Gy/15 fr
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Conclusion:Radical radiotherapy is feasible and effective for elderly or unfit patients.Three-year locoregional control after radical radiotherapy using a boost technique was 72%, with low rates for late urinary and intestinal toxicity.Early and late toxicity rates were reduced by using IMRT.
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Six cases of angiosarcoma of the scalp are reported. The tumors are histologically indistinguishable from the "postmastectomy" lymphangiosarcomas reported by Stewart and Treves. With a single exception they were extensive, aggressive neoplasms that widely infiltrated the dermis and soft tissues. Although these tumors are rare malignancies of the skin, there appears to be a peculiar, unexplained predilection for the scalp.
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Angiosarcoma of the scalp is a relatively rare skin malignant disorder. We experienced a case of angiosarcoma. A 74-year-old woman admitted our hospital with a tumor which had appeared 1 month before on her right frontal scalp. Three months ago she got injures for two times on the scalp where exact same place the tumor appeared. She was diagnosed as angiosarcoma by typical clinical and histopathological features. She was intensively treated with rIL-2 and surgical operation. Intra-arterial infusion of rIL-2 was carried out before the operation. After the operation she was treated with intra-venous infusion of rIL-2. At the time of beginning the treatment, diameter of the tumor was 5cm and decreased to 3cm just before the operation. We estimated the IL-2 therapy benefitable for decreasing the tumor-size. No recurence is observed until now. [Skin Cancer (Japan) 2000; 15 : 276-279]
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ABSTRACT Background The primary purpose of this study was to examine whether angiosarcoma outcomes differ for the scalp and face. Methods We conducted a retrospective outcomes analysis of 50 patients with cutaneous angiosarcoma treated by curative intent identified from the Princess Margaret Cancer Centre Registry (from 1958 to 2014). Results Median survival was 26 months (95% confidence interval [CI], 17.6–34.6) and median follow‐up 29 months. For the scalp and face, respectively, the 5‐year locoregional control rate was 9% and 53% ( p = .04); the recurrence‐free survival (RFS) rate was 5% and 27% ( p = .017); and the overall survival (OS) rate was 9% and 26% ( p = .017). Scalp lesions were larger, more likely to be multifocal, and presented more rapidly once noticed. In multivariate Cox proportional hazards analysis, scalp location was independently prognostic for mortality (hazard ratio [HR], 2.10; 95% CI, 1.03–4.28; p = .04). Conclusion Scalp angiosarcoma has worse survival than angiosarcoma of the face. Scalp angiosarcoma tends to be larger at presentation, which may be because it is not noticed until more advanced. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1205–1211, 2017
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Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to identify clinicopathological factors associated with the recurrence of PTs.From January 2009 to December 2019, we identified 100 patients who underwent definitive surgery for PT. Clinicopathological risk factors associated with the recurrence of PT were assessed.The median age of the patients was 44 y (range, 19-62 y), and the median tumor size was 4 cm (0.8-30 cm). At a median follow-up of 26.7 mo (0-103 mo), 22 of the 100 patients experienced local recurrence. In the univariate and multivariate analyses, body mass index ≥ 23 kg/m2 (P = 0.042 in the univariate analysis; P = 0.039 in the multivariate analysis), tumor size ≥ 5 cm (P = 0.006 in the univariate analysis; P = 0.036 in the multivariate analysis), and the presence of stromal overgrowth (P = 0.032 in the univariate analysis; P = 0.040 in the multivariate analysis) were associated with an increased risk of local recurrence. Resection margins and grade were not associated with local recurrence.Normal- or underweight patients and those with larger tumor sizes were more prone to local recurrence. Further larger, multicenter studies with a long-term follow-up are required.
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Six cases of angiosarcoma of the scalp are reported. The tumors are histologically indistinguishable from the "postmastectomy" lymphangiosarcomas reported by Stewart and Treves. With a single exception they were extensive, aggressive neoplasms that widely infiltrated the dermis and soft tissues. Although these tumors are rare malignancies of the skin, there appears to be a peculiar, unexplained predilection for the scalp.
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Abstract Background Primary cutaneous angiosarcoma (CA) is a rare but aggressive tumor with a high rate of local recurrence. This study was designed to analyze the clinicopathological features of primary CA and identify factors of cutaneous manifestations associated with the prognosis of angiosarcoma. Methods Medical records of 55 patients with primary CA were retrospectively analyzed to investigate clinical features, survivals, and prognostic factors. Anatomical location of tumor was classified to the scalp, face, and neck, and sites outside the head and neck. Results Primary CA presented cutaneous nodules (31/55, 47.2%), patches (13/55, 23.6%), and indurated plaques (11/55, 20.0%). Nodular lesion was significantly more common in CA on the scalp compared to CA on sites outside the scalp. Histologically, tumors presenting as nodular lesions on the scalp was predominantly composed of solid sheets of large pleomorphic cells, whereas non‐nodular lesions composed of tumor cells between collagen bundles forming irregular vascular spaces. Cutaneous angiosarcoma on the scalp showed a worse prognosis compared to CA on sites outside the scalp. Patients presenting clinical morphology with nodules and multiple skin lesions showed significantly reduced overall survival (OS). Conclusion In primary CA, location on the scalp, morphology with nodules, and multiplicity of skin lesions significantly affected survival outcomes.
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Cutaneous angiosarcoma (AS) of the face and scalp of the elderly is an uncommon neoplasm of mesenchymal origin characterized by particularly aggressive behavior. It is frequently discovered after local trauma and clinically it may appear as a benign, inflammatory lesion. In most patients, a definitive diagnosis is delayed, leading to a poor prognosis. Only early diagnosis can modify this course, as treatment in the initial stages of [...]
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A 80-year-old woman presented with a spontaneously bleeding wound on her scalp. The diagnosis of angiosarcoma was made based on histopathological examination of the second biopsy 1 month later. At that time, a large hematoma was present on the scalp and forehead with two bleeding erosions and numerous small blue-black nodules as well as a right cervical lymphadenopathy. The patient was treated by wide-field electron-beam radiotherapy, which showed no effect. The particularly aggressive evolution of this angiosarcoma led to death within less than 2 months.
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