Heinhuis Kimberley M, IJzerman Nikki S, van der Graaf Winette T A, Kerst Jan Martijn, Schrage Yvonne, Beijnen Jos H, Steeghs Neeltje, van Houdt Winan J
Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Cancers (Basel). 2020 Aug 12;12(8):2251. doi: 10.3390/cancers12082251.
Angiosarcoma is an extremely rare and aggressive malignancy. Standard of care of localized tumors includes surgery ± radiation. Despite this multimodal treatment, >50% of the angiosarcoma patients develop local or distant recurrent disease. The role of neoadjuvant systemic therapy is still controversial and we therefore performed a systematic review of the literature to define the role of neoadjuvant systemic therapy based on available evidence. We focused on the effects of neoadjuvant systemic therapy on: 1. The success of surgical resection and 2. the long-term survival. All articles published before October 2019 on Ovid Medline, Ovid Embase, Cochrane library and Scopus were evaluated. Eighteen case reports and six retrospective cohort studies were included. There were no randomized controlled trials. This literature showed a beneficial role of neoadjuvant chemotherapy on downsizing of the tumor resulting in an improvement of the resection margins, especially in patients with cardiac or cutaneous angiosarcoma. However, no definitive conclusions on survival can be drawn based on the available literature lacking any prospective randomized studies in this setting. We advise that neoadjuvant chemotherapy should be considered, since this could lead to less mutilating resections and a higher rate of free resection margins. An international angiosarcoma registry could help to develop guidelines for this rare disease.
血管肉瘤是一种极其罕见且侵袭性强的恶性肿瘤。局限性肿瘤的标准治疗方法包括手术±放疗。尽管采用了这种多模式治疗，但超过50%的血管肉瘤患者会出现局部或远处复发性疾病。新辅助全身治疗的作用仍存在争议，因此我们对文献进行了系统回顾，以根据现有证据确定新辅助全身治疗的作用。我们重点关注新辅助全身治疗对以下方面的影响：1. 手术切除的成功率；2. 长期生存率。对2019年10月之前在Ovid Medline、Ovid Embase、Cochrane图书馆和Scopus上发表的所有文章进行了评估。纳入了18篇病例报告和6项回顾性队列研究。没有随机对照试验。该文献表明新辅助化疗对肿瘤缩小具有有益作用，从而改善了切缘，尤其是在心脏或皮肤血管肉瘤患者中。然而，由于现有文献缺乏该情况下的任何前瞻性随机研究，因此无法就生存率得出明确结论。我们建议应考虑新辅助化疗，因为这可能导致切除范围更小，切缘阴性率更高。一个国际血管肉瘤登记处有助于为这种罕见疾病制定指南。
