Mitra Devarati, Devlin Phillip M, Buzurovic Ivan, Thornton Katherine, Lam Allen C, Raut Chandrajit P, Baldini Elizabeth H, Lam Miranda B
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA.
Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
J Contemp Brachytherapy. 2021 Apr;13(2):172-178. doi: 10.5114/jcb.2021.105285. Epub 2021 Apr 14.
Angiosarcoma is a sub-type of soft tissue sarcoma, often presenting as a multifocal or diffuse disease process with poor prognosis. This study presents outcomes of a single institution cohort of patients with angiosarcoma of the scalp and face following treatment with multimodality therapy, including high-dose-rate surface applicator (HDR-SA) brachytherapy, and represents the largest cohort utilizing this therapeutic approach.
Twenty patients with primary or recurrent angiosarcoma of the face or scalp were treated with HDR-SA brachytherapy between 2003-2018, with clinical characteristics and outcomes collected from medical records and used to identify prognostic features.
Median follow-up was 45 months. Patients treated with HDR-SA brachytherapy had a 4-year local control rate of 63%, a 4-year progression-free survival (PFS) rate of 20%, and a 4-year overall survival rate of 54%. Disease features associated with worse loco-regional control (LRC) included location on the scalp (vs. face, = 0.04) and tumor size ≥ 5 cm ( = 0.0099). Outcomes after HDR-SA brachytherapy for salvage therapy vs. HDR-SA brachytherapy as a component of an initial treatment approach were also significantly different, with worse LRC ( = 0.0084) and worse overall survival (OS) ( = 0.0019) in a setting of salvage therapy.
Local control rates following HDR-SA brachytherapy for scalp or face angiosarcoma are moderate and similar to what is described in the literature using a variety of local control treatment modalities. Smaller tumors and those involving the face rather than scalp had better outcomes. PFS rates were poor and there is a pressing need for treatment intensification and novel therapeutic options.
血管肉瘤是软组织肉瘤的一种亚型，常表现为多灶性或弥漫性疾病过程，预后较差。本研究呈现了单一机构中头皮和面部血管肉瘤患者接受多模态治疗（包括高剂量率表面敷贴器近距离放疗）后的治疗结果，这是采用该治疗方法的最大队列研究。
2003年至2018年间，20例面部或头皮原发性或复发性血管肉瘤患者接受了高剂量率表面敷贴器近距离放疗，从病历中收集临床特征和结果以确定预后特征。
中位随访时间为45个月。接受高剂量率表面敷贴器近距离放疗的患者4年局部控制率为63%，4年无进展生存率为20%，4年总生存率为54%。与局部区域控制较差相关的疾病特征包括位于头皮（与面部相比，P = 0.04）和肿瘤大小≥5 cm（P = 0.0099）。高剂量率表面敷贴器近距离放疗作为挽救治疗与作为初始治疗方法的组成部分的治疗结果也有显著差异，在挽救治疗情况下局部区域控制较差（P = 0.0084）且总生存率较差（P = 0.0019）。
高剂量率表面敷贴器近距离放疗治疗头皮或面部血管肉瘤后的局部控制率中等，与文献中使用各种局部控制治疗方式所描述的相似。较小的肿瘤以及累及面部而非头皮的肿瘤预后较好。无进展生存率较差，迫切需要加强治疗和新的治疗选择。
