Bullen R, Larson P O, Landeck A E, Nychay S, Snow S N, Hazen P, Kinsella T, Lamond J
Department of Surgery, University of Wisconsin Medical School, Madison, USA.
Dermatol Surg. 1998 Oct;24(10):1105-10. doi: 10.1111/j.1524-4725.1998.tb04083.x.
Cutaneous angiosarcoma (AS) is a rare, often multicentric vascular tumor of the head and neck region with a rather poor prognosis. The original clinical size of the tumor rarely correlates to the degree of microscopic tissue invasion. Treatment by surgical excision sometimes requires very wide excision. Treatment by radiation or electron beam appears less mutilating but its efficacy is not well documented.
To present our experience with a combined surgical delineation of tumor margins followed by radiation treatment.
We treated three patients with extensive AS of the scalp and face. Prior to radiation, in two cases the tumor margins were determined by grid-pattern punch biopsies. In the third patient, the tumor margins were determined by Mohs mapping system. All three patients then received radiation either by rotational arc electron beam (n = 2) and standard radiation.
One patient developed two local recurrences in nonirradiated areas plus a metastatic cervical node, all of which responded to additional electron beam. The patient has no evidence of disease (NED) after 30 months of observation. The other two patients were treated by electron beam and radiation have NED at 5 and 1 years follow-up, respectively.
Local control of AS of the scalp may be achieved by assessment of the tumor margin by peripheral biopsies or Mohs technique followed by electron beam and radiation.
皮肤血管肉瘤（AS）是一种罕见的、常为多中心性的头颈部血管肿瘤，预后较差。肿瘤的原始临床大小与微观组织浸润程度很少相关。手术切除治疗有时需要非常广泛的切除。放射治疗或电子束治疗似乎造成的损伤较小，但其疗效尚无充分记录。
介绍我们采用手术确定肿瘤边缘后联合放射治疗的经验。
我们治疗了3例头皮和面部广泛AS患者。在放射治疗前，2例通过网格状点状活检确定肿瘤边缘。第3例患者通过莫氏图谱系统确定肿瘤边缘。然后，所有3例患者均接受了旋转弧形电子束放疗（2例）和标准放疗。
1例患者在未照射区域出现2次局部复发，外加1个颈部转移淋巴结，所有这些均对额外的电子束治疗有反应。观察30个月后，该患者无疾病证据（NED）。另外2例接受电子束和放射治疗的患者分别在随访5年和1年时达到NED。
通过外周活检或莫氏技术评估肿瘤边缘，随后进行电子束和放射治疗，可实现头皮AS的局部控制。
