Angiosarcoma of the liver with metastasis to the cervical spine cured with the treatment of thalidomide and radiotherapy

Management Strategies and Outcomes in Primary Liver Angiosarcoma

OBJECTIVES

Primary hepatic angiosarcoma is a rare tumor of the liver that originates from endothelial and fibroblastic tissue, with poor prognosis and lack of standardized treatment. We retrospectively analyzed the clinical characteristics and treatment outcomes of 23 patients with primary liver angiosarcoma treated at an academic sarcoma center.

METHODS

We screened all patients with primary liver angiosarcoma treated at Stanford between 2000 and 2022. Data was collected from EPIC electronic medical records and included patient demographics, tumor characteristics, treatment modalities, and patient outcomes. Statistical analysis was completed using Python 3.0, while survival curves were generated using the Kaplan-Meier method and Lifelines Packages.

RESULTS

There were nearly equal numbers of males (11) and females (12) in our study, with most patients aged 70 to 79 at diagnosis. The median overall survival (OS) was 6 months (range 0.07 to 222.6 mo). The 2- and 5-year OS were both 38.6%. 71% of patients received systemic treatment with chemotherapy, while 29% received immunotherapy. Local treatment with surgery or radioembolization was performed in 14% of patients. Three patients in our study displayed particularly improved OS and received various treatments, which ranged from hepatic resection to ipilimumab/nivolumab.

CONCLUSION

Our study demonstrated that primary liver angiosarcoma has poor outcomes despite treatment. Surgical resection with negative margins is the only curative modality. However, most patients present with advanced disease and are not surgical candidates. Further research is needed to identify more effective systemic therapy options for this devastating disease.

Therapy of Angiosarcoma with Thalidomide and Lenalidomide

Angiosarcoma is an uncommon malignancy with a poor prognosis. Systemic therapy options for patients with metastatic disease generally have limited effectiveness. In this case study, a 73-year-old male with metastatic angiosarcoma who previously declined chemotherapy and developed progressive disease after checkpoint inhibitor immunotherapy elected to try thalidomide based on 6 case reports describing its effectiveness. Thalidomide resulted in stable disease for 9 months, but due to severe neuropathy as a side effect, lenalidomide was then substituted for thalidomide. The patient continued to have stable disease on lenalidomide for an additional 16 months and ongoing. This is the first case study to report on effective treatment of angiosarcoma with lenalidomide. Further investigation of lenalidomide in the management of angiosarcoma is warranted.

Surgery and chemotherapy improve the prognosis of primary hepatic angiosarcoma: A retrospective study based on Propensity score matched survival analysis

PURPOSE

Hepatic angiosarcoma(HAS) is rare and is the primary vascular-derived malignancy of the liver. Its clinical characteristics, therapeutic strategy management, and the outcome are unclear.

METHODS

This is a retrospective study of patients from the SEER database. Survival analysis was performed by the Kaplan-Meier method. Univariate and multivariate Cox models were used to identify risk factors. Propensity Score Matching(PSM) analysis was used to remove confounding bias. The nomogram was constructed, and the performance was measured using the C-index.

RESULTS

A total of 300 HAS patients diagnosed between 1975 and 2016 were identified for this study, with an estimated median cancer-specific survival(CSS) of 1 month. The median CSS was 6 months in both the surgery and chemotherapy groups. Age(HR = 1.5206, p = 0.0058), sex(HR = 1.3906, p = 0.0391), SEER stage(HR = 1.4426, p < 0.0001), surgery(HR = 0.4493, p = 0.0001) and chemotherapy(HR = 0.28161, p < 0.0001) are potential independent prognostic factors. Of these HAS patients, 29 received surgical treatment without chemotherapy, and 63 received chemotherapy without surgery. A 1:1 PSM was performed to select candidates from the surgery-only group and the chemotherapy-only group. The survival analysis showed that the median survival time was 3 months in the surgery-only cohort and 5 months in the chemotherapy-only cohort, and there was no statistical difference between the two groups. Finally, a nomogram was constructed, with a C-index of 0.754.

CONCLUSIONS

HAS is uncommon and has a poor prognosis. It was found that age, sex, SEER stage, surgery, and chemotherapy were independent prognostic factors for patients. Both surgery and chemotherapy could significantly prolong the survival of patients, and there was no statistical difference between the prognosis of patients treated with chemotherapy alone and those treated with surgery alone.

A pooled analysis of treatment and prognosis of hepatic angiosarcoma in adults

BACKGROUND

Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges. The aim of the present study was to determine the treatment and prognosis of this entity.

DATA SOURCES

A systematic literature search was conducted using PubMed, Embase and Chinese Biomedical Literature database, to identify articles published from January 1980 to July 2017. Search terms were "hepatic angiosarcoma" and "liver angiosarcoma". Additional articles were retrieved through manual search of bibliographies of the relevant articles. Pooled individual data concerning the prognosis following various therapeutic modalities were analyzed.

RESULTS

A total of 75 articles involving 186 patients were eligible for inclusion. The median overall survival (OS) was 8 months, with 1-, 3-, and 5-year OS rates of 36.6%, 22.3%, and 12.0%, respectively. The median OS after partial hepatectomy (n = 86), chemotherapy (n = 36), liver transplantation (n = 17), and supportive care (n = 46) were 15, 10, 5 and 1.3 months, respectively. Small tumor size (<10 cm) was the only significant favorable factor for OS after partial hepatectomy (P = 0.012).

CONCLUSIONS

Despite the dismal prognosis, partial hepatectomy could prolong the survival of hepatic angiosarcoma patients, particularly those with tumors <10 cm. Chemotherapy could be an option for unresectable disease. Liver transplantation is not a recommendable option for the management of this malignancy.