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Kwapnoski Z, Clarey D, Ma J, Schmidt CM, Wysong A. Cutaneous Angiosarcoma Subtypes: A Quantitative Systematic Review of Demographics, Treatments, and Outcomes Within Published Patient-Level Cases. Dermatol Surg 2024; 50:620-626. [PMID: 38530994 DOI: 10.1097/dss.0000000000004174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy arising from the vascular endothelium. Given its rarity, there is insufficient data detailing patient demographics, management, and survival outcomes. OBJECTIVE To systematically compile published patient-level cases of cAS and to quantify and analyze data on demographics, management, and outcomes while determining prognostic indicators. MATERIALS AND METHODS Searches of EBSCOhost, MEDLINE, EMBASE, and the Cochrane Library generated 1,500 cases of cAS with individual level data available. PRISMA guidelines were followed. RESULTS Cutaneous angiosarcoma presented most often on the scalp of elderly men. Metastasis occurred in 36.3% of cases. Aggregate 5-year survival was 31.6% with the median survival of 25 months. The best 5-year survival was in the radiation-associated subtype (48.8%), whereas the worst was in the Stewart-Treves subtype (21.6%). Using multivariate analysis, gender, age group, disease subtype, treatment modality, and metastasis at presentation had significant effects on survival outcomes ( p < .05). CONCLUSION The breadth of information obtained enables this study to serve as a resource that clinicians may reference when they encounter cAS.
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Affiliation(s)
- Zachary Kwapnoski
- Department of Dermatology, University of California Davis, Sacramento, CA
| | - Dillon Clarey
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
| | - Jihyun Ma
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Cynthia M Schmidt
- University of Nebraska, Medical Center, Leon S. McGoogan Health Sciences Library, Omaha, NE
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
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2
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Li D, Sun Z, Ma L, Liu S. Recurrence of scalp angiosarcoma after multiple surgeries: A case report and literature review. Oncol Lett 2023; 26:536. [PMID: 38020301 PMCID: PMC10655065 DOI: 10.3892/ol.2023.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Scalp angiosarcoma (SA) is rare, accounting for <1% of soft tissue sarcomas, with a high degree of malignancy, a high recurrence rate and a poor prognosis. The best treatment strategy is uncertain. Therefore, it is essential to continuously refine treatment strategies and improve the prognosis of patients. Curative-intent surgery increases overall survival in patients with primary cutaneous angiosarcoma of the scalp and face, and radiation therapy combined with chemotherapy is now recommended for the curative treatment of patients who both can or cannot undergo surgery. The present case report is of an 87-year-old man hospitalised for the fifth time with SA. He had experienced four recurrences and previously underwent curative-intent surgery four times. However, the patient did not undergo radiotherapy or chemotherapy after any of the surgeries. A detailed report of the management of this case is presented along with a review of the relevant literature. It is hypothesised that patients with SA should receive a combination of radiotherapy and chemotherapy after surgery whenever possible, which may improve patient prognosis.
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Affiliation(s)
- Dongjian Li
- Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, P.R. China
- Department of Plastic and Burn Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zhiguo Sun
- Department of Clinical Medicine, Yanggu County Central Hospital, Liaocheng, Shandong 252300, P.R. China
| | - Ling Ma
- Department of Plastic and Burn Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Shaohua Liu
- Department of Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
- Institute of Stomatology, Shandong University, Jinan, Shandong 250012, P.R. China
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3
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Rohr E, Laverde-Saad A, Zargham H, Chergui M, Watters K, Balbul A. An unusually indolent well-differentiated Wilson-Jones angiosarcoma: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231212988. [PMID: 38022853 PMCID: PMC10656791 DOI: 10.1177/2050313x231212988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Cutaneous angiosarcomas are rare soft tissue tumours originating from hematogenous vasculature that are aggressive and carry a poor prognosis. We describe the case of a 73-year-old man with a low-grade well-differentiated angiosarcoma. Our case distinguishes itself from those previously reported in the slow progression and important delay to the presentation of 30 months and survival time of 5.5 years. Additionally, its severe clinical appearance (T2 stage) but milder pathological picture (T1 stage) is very uncommon. A repeat biopsy is warranted when results are inconclusive and there is a high clinical suspicion of angiosarcoma.
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Affiliation(s)
- Eliana Rohr
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Hanieh Zargham
- Department of Dermatology and Skin Science, The Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - May Chergui
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Kevin Watters
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Alfred Balbul
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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4
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Rossi AN, Veronesi G, Dika E. The role of confocal microscopy in recurrent cutaneous angiosarcoma. Skin Res Technol 2023; 29:e13423. [PMID: 37632190 PMCID: PMC10390705 DOI: 10.1111/srt.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Alice Nadia Rossi
- Section of Dermatology, Department of Medical and Surgical Sciences (DIMEC)Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Giulia Veronesi
- Section of Dermatology, Department of Medical and Surgical Sciences (DIMEC)Alma Mater Studiorum, University of BolognaBolognaItaly
| | - Emi Dika
- Section of Dermatology, Department of Medical and Surgical Sciences (DIMEC)Alma Mater Studiorum, University of BolognaBolognaItaly
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
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5
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Szczepanski JM, Siddiqui J, Patel RM, Harms PW, Hrycaj SM, Chan MP. Expression of SATB2 in primary cutaneous sarcomatoid neoplasms: a potential diagnostic pitfall. Pathology 2023; 55:350-354. [PMID: 36732203 DOI: 10.1016/j.pathol.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
SATB2 can be used as an immunohistochemical marker for osteoblastic differentiation. The differential diagnosis of a cutaneous sarcomatoid neoplasm sometimes includes osteosarcoma when the tumour concomitantly involves the skin, soft tissue, and bone, or when there is a past medical history of osteosarcoma. As the utility of SATB2 immunohistochemistry in these scenarios was unclear, we aimed to determine the frequency and the pattern of SATB2 expression in a variety of cutaneous sarcomatoid neoplasms. SATB2 expression by immunohistochemistry was evaluated by intensity (0-3) and extent (0-100%) of staining to generate an h-score for each case. Expression levels were classified into high-positive (h-score ≥100), low-positive (20-99), and negative (<20) groups. Positive SATB2 expression was observed in 18/23 (78%) atypical fibroxanthomas (AFX), 10/19 (53%) pleomorphic dermal sarcomas, 9/20 (45%) cutaneous sarcomatoid squamous cell carcinomas, 14/39 (36%) sarcomatoid melanomas, 2/13 (15%) poorly differentiated cutaneous angiosarcomas, 10/17 (59%) high-grade cutaneous leiomyosarcomas, and 7/8 (88%) osteosarcoma controls. With the exception of AFX, all cutaneous neoplasms showed significantly lower average h-scores than osteosarcoma. AFX gave the highest average h-score (71) and percentage of high-positive cases (48%) among all examined cutaneous neoplasms. Only two (1.5%) of all cutaneous cases showed strong intensity of staining. Common SATB2 expression in various cutaneous sarcomatoid neoplasms poses a potential diagnostic pitfall when the differential diagnosis includes osteosarcoma. Requirement of strong staining and a high-positive h-score improves the specificity of SATB2 in differentiating these tumours from osteosarcoma.
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Affiliation(s)
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Steven M Hrycaj
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
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6
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Kumari J, Das K, Patil A, Babaei M, Cockerell CJ, Goldust M. Clinical update on cutaneous and subcutaneous sarcomas. J Cosmet Dermatol 2023; 22:402-409. [PMID: 36074118 DOI: 10.1111/jocd.15369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous sarcomas are uncommon cancers that can have a wide range of clinical symptoms and lead to considerable cutaneous as well as systemic morbidity. AIM The objective of this review article is to discuss epidemiology, clinical features, diagnosis, and therapy of different types of cutaneous sarcomas. MATERIAL AND METHODS Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analyses, and relevant information from selected websites were included. RESULTS AND DISCUSSION Cutaneous sarcomas have a negative effect on the quality of life. In their diagnosis, clinical presentation and histological evaluation are crucial. Complete surgical removal is the solution for more or less all cutaneous and subcutaneous sarcomas. The prognosis for cutaneous sarcomas is generally favorable since they tend to recur locally with distant metastases only on rare occasions. Patients having advanced disease should be treated in the setting of clinical trials if possible; choices include radiation therapy and systemic medicines. The value of innovative immunotherapy cannot be determined decisively at this time due to a paucity of relevant trials. CONCLUSION As cutaneous sarcomas are rarely diagnosed based on clinical findings, histology plays an important role in the diagnosis. They have a relatively favorable prognosis if treated properly. Patients should be treated at specialized centres.
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Affiliation(s)
- Jyoti Kumari
- Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kinnor Das
- Department of Dermatology Venereology and Leprosy, Silchar Medical College, Silchar, Assam, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Mahsa Babaei
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Clay J Cockerell
- Departments of Dermatology and Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Cockerell Dermatopathology, Dallas, Texas, USA
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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7
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Hwang G, Shin J, Lee JY, Na KS, Paik JS, Yim HW, Yang SW, Cho WK. The Eyelid Angiosarcoma: A Systematic Review of Characteristics and Clinical Course. J Clin Med 2022; 11:jcm11144204. [PMID: 35887967 PMCID: PMC9320659 DOI: 10.3390/jcm11144204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023] Open
Abstract
A systematic search for eyelid angiosarcoma was performed from inception to December 2020 in Medline, EMBASE, and the Cochrane databases. Forty two eyelid angiosarcoma cases in 32 articles were analyzed. Eyelid angiosarcomas showed an incidence peak in the eighth decade of life, and was reported more frequently in Caucasian males. Eyelid angiosarcomas were associated with a mortality rate of 26.2%, a recurrence rate of 14.3%, and a cure rate of 45.2%. Four years event-free survival (EFS) rate was 36.0%, with median EFS of 36 months. Eyelid angiosarcomas with bilateral involvement or metastasis showed higher mortality and recurrence rates than unilateral eyelid invasion cases. In the prognosis analysis according to treatment modalities, the mortality and recurrence rates were the lowest in patients who underwent surgical excision. The 4-year EFS probability in a group with surgical excision was 60.6%, but in a group without surgical excision it was 30.3%. A total of 45.2% of the cases was misdiagnosed and 21.4% of the cases could not be correctly diagnosed with the first biopsy trial. The prognosis for eyelid angiosarcomas was better than that of angiosarcomas invading the face and scalp. Surgical excision was the most important treatment modality; thus, should be considered as the first treatment of choice.
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Affiliation(s)
- Gyudeok Hwang
- Department of Ophthalmology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (G.H.); (J.S.); (J.-Y.L.)
| | - Jeongah Shin
- Department of Ophthalmology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (G.H.); (J.S.); (J.-Y.L.)
| | - Ji-Young Lee
- Department of Ophthalmology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (G.H.); (J.S.); (J.-Y.L.)
| | - Kyung-Sun Na
- Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (K.-S.N.); (J.-S.P.)
| | - Ji-Sun Paik
- Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (K.-S.N.); (J.-S.P.)
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Suk-Woo Yang
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Won-Kyung Cho
- Department of Ophthalmology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (G.H.); (J.S.); (J.-Y.L.)
- Correspondence: ; Tel.: +82-42-220-9590
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8
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Messias H, Martins M, Zagalo C, Gomes P. Multifocal cutaneous angiosarcoma of the scalp—A challenging reconstructive case managed with skin substitutes. Cancer Rep (Hoboken) 2022; 5:e1659. [PMID: 35819124 PMCID: PMC9575495 DOI: 10.1002/cnr2.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cutaneous angiosarcoma (AS) of the head and neck is a rare highly aggressive tumor, often associated with difficult local control of the disease and poor prognosis. This article describes a case of multifocal cutaneous AS of the scalp, mainly addressing its difficult surgical management and challenging reconstruction and concludes with a review of the literature. Methods A 70‐year‐old Caucasian male was referred to our hospital with a growing scalp lesion initially suspected to be benign, but later diagnosed with AS. Results The patient had tumor recurrence and a difficult reconstruction for which dermal substitutes proved very useful. Conclusion AS can mimic a benign lesion in its early stages. Skin substitutes, namely dermal templates, can be useful to meet the complex needs of reconstruction and oncological surveillance of patients with AS.
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Affiliation(s)
- Henrique Messias
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
- Division of Health Sciences University of Edinburgh Edinburgh United Kingdom
| | - Mariluz Martins
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
| | - Carlos Zagalo
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
| | - Pedro Gomes
- Head and Neck Surgery Department Portuguese Institute of Oncology Francisco Gentil Lisbon Portugal
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9
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Irawati N, Moghadam A, Abdul-Razak M, Strach M, Elliott M, Ch'ng S, Shannon K, Palme CE, Clark J, Wykes J, Low THH. Outcomes after definitive treatment for head and neck angiosarcoma. ANZ J Surg 2022; 92:1407-1414. [PMID: 35531880 DOI: 10.1111/ans.17695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Head and neck angiosarcoma (HN-AS) is a rare and aggressive, representing <1% of all head and neck malignancies. It is characterized by a high rate of local recurrence and poor 5-year survival (10-54%). Australian data in this rare disease is lacking. We aim review the clinical outcomes of HN-AS from two high volume head and neck cancer units in Australia. METHODS Retrospective chart review. RESULTS A total 26 patients were identified, consist of predominantly male patients (81%) with a mean age of 77 year old. Most of the HN-AS arises from the scalp (62%). The 5-year overall survival (OS) and disease free survival (DFS) were 41% and 15%, respectively. Patients treated with upfront surgery with adjuvant therapy has better OS and DFS compared with patients receiving upfront chemoradiotherapy (median OS 3.63 vs. 0.53 years, P = 0.011 and median DFS 1.19 vs. 0.33 years, P = 0.001). There is no difference in OS or DFS for the sites of HN-AS or age of patients. Recurrences were noted in 15 patients (57.7%). For those with metastatic disease, the most common site was the lung (80%) with a median time to development of distant disease of 2.7 years (range 1.8-3.6 years). In patients who underwent salvage treatment, the median survival (post-salvage) was 1.3 years (0-2.8 years). CONCLUSION This is the first Australian report of treatment patterns and outcomes of patients with HN-AS. Our cohort confirms that HN-AS is a slowly progressive disease with poor survival. Patients treated with surgery and adjuvant radiotherapy in this series had better outcomes compared with those treated with chemoradiotherapy alone. The role of neoadjuvant chemotherapy is an area of ongoing research.
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Affiliation(s)
- Nina Irawati
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | | | | | - Madeleine Strach
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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10
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Kashihara T, Igaki H, Ogata D, Nakayama H, Nakamura S, Okuma K, Mori T, Yamakawa K, Takahashi A, Namikawa K, Takahashi A, Takahashi K, Kaneda T, Inaba K, Murakami N, Nakayama Y, Okamoto H, Yamazaki N, Itami J. Prognostic factor analysis of definitive radiotherapy using intensity-modulated radiation therapy and volumetric modulated arc therapy with boluses for scalp angiosarcomas. Sci Rep 2022; 12:4355. [PMID: 35288619 PMCID: PMC8921322 DOI: 10.1038/s41598-022-08362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Cutaneous angiosarcomas is a rare cancer with poor prognoses. The common radiotherapy techniques that have been reported so far are two pairs of lateral X-ray and electron fields. However, it is quite difficult to irradiate scalp angiosarcomas (SAs) homogeneously with this technique. In this study, safety, effectiveness, and risk factors were assessed for localized SAs ≥ 5 cm treated with intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) with boluses. Sixty-eight angiosarcoma patients who had received radiotherapy in our institution between January 2007 and November 2020 were retrieved from our radiotherapy database. Of these patients, 27 localized SA patients were included in the retrospective analysis. The 2-year overall survival, local progression-free rate, and distant metastases-free survival were 41.8%, 48.4%, and 33.1%. All the patients experienced acute radiation dermatitis ≥ grade 2, with18 (66.7%) ≥ grade 3. No nodule lesion was a significant unfavorable predictive factor of acute radiation dermatitis ≥ grade 3. Tumor bleeding at the initiation of radiotherapy and tumor invasion to the face were significant predictive factors of overall survival, and tumor bleeding at the initiation of radiotherapy was also a significant predictive factor of local progression-free rate.
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11
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Sakisaka S, Tanabe M, Imayama S, Zeze N, Yamana K, Yoshikawa H, Sonoda KH. Two Cases of Angiosarcoma with Persistent Unilateral Eyelid Swelling. Ocul Oncol Pathol 2022; 8:16-21. [PMID: 35356598 PMCID: PMC8914193 DOI: 10.1159/000520293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023] Open
Abstract
Angiosarcoma is a widely known neoplasm with one of the poorest prognoses; however, such cases are rarely observed by the ophthalmologists in clinical practice. The tumor commonly develops on the face and scalp and may cause eyelid swelling. We present 2 such cases. Case 1 was an 82-year-old woman who presented with indulated swelling of the right eyelid that extended to the upper forehead. Biopsy revealed a poorly circumscribed tumor infiltrated throughout the dermis and fat tissue, exhibiting both angiomatous and solid patterns. Immunohistochemistry showed CD31(-) and D2-40/podoplanin(+), suggesting angiosarcoma. The patient had multiple lung metastases and died 14 months later. Case 2 was a 77-year-old man who presented with swelling of the left eyelid, and erythema on the left temporal skin developed ulcerated nodules. Biopsy showed proliferated tumor cells in a sheet form, extensively throughout the dermis. Angiosarcoma was preferred based on immunohistochemistry: CD31(+), CD34(+), and D2-40(-). The patient was treated with electron beam therapy and chemotherapy and died after 13 months. It would be difficult for an ophthalmologist to suspect such a rare neoplasm only from swelling of the eyelids. However, angiosarcoma should be considered if the swelling spreads steadily from a head rash with a nodule or ulcer nearby.
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Affiliation(s)
- Shinzo Sakisaka
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan,*Mika Tanabe,
| | - Mika Tanabe
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan,*Mika Tanabe,
| | | | - Nahoko Zeze
- Department of Dermatology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Kanako Yamana
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroshi Yoshikawa
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
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12
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Periasamy K, Das N, Khosla D, Kapoor R. Recurrent angiosarcoma of scalp with opsoclonus myoclonus syndrome: role of salvage treatment. BMJ Case Rep 2021; 14:14/6/e241824. [PMID: 34172478 DOI: 10.1136/bcr-2021-241824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cutaneous angiosarcoma is a type of rare and locally aggressive malignancy requiring individualised treatment owing to paucity of randomised trials. We present the case of a middle-aged cancer survivor with locally advanced angiosarcoma of scalp managed with surgery, radiotherapy, chemotherapy and targeted therapy over a course of 6 years for two recurrences. The first recurrence was preceded by opsoclonus myoclonus syndrome, a type of paraneoplastic neurological syndrome (PNS), rarely reported in sarcomas. The second recurrence had a rapid clinical course, which led to a therapeutic dilemma of best supportive care versus active management. A trial of weekly paclitaxel was started that was continued for a total of 12 cycles with good objective clinical response. Presently, he is tolerating maintenance pazopanib well and is symptom free for 6 months. In cutaneous angiosarcoma patients, PNS may be a harbinger of recurrence and aggressive, multimodality treatment helps prolong survival.
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Affiliation(s)
- Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Das
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Director, Homi Bhabha Cancer Hospital, Sangrur, India
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13
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Wang P, Xu L, Yang Y. A Rare Cause of Pulmonary Nodules Diagnosed as Angiosarcoma Was Misdiagnosed as Vasculitis and Wegener's Granuloma in an Elderly Man: A Case Report. Front Oncol 2021; 11:629597. [PMID: 34026609 PMCID: PMC8131857 DOI: 10.3389/fonc.2021.629597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background Angiosarcoma is a rare, highly malignant tumor prone to recurrence and metastasis. Angiosarcoma is insidious in the initial stage, and its clinical manifestation lacks specificity. The diagnosis is based on histopathology and immunohistochemistry findings. Case presentation A 73-year-old man was hospitalized following complaints of persistent cough 6 months and hemoptysis for 2 months. Anti-infective treatment was ineffective. A CT-guided percutaneous core needle biopsy of pulmonary lesions revealed organized pneumonia, and the removed skin of purpuric rash area on the left calf revealed vasculitis. Chest CT was used during the patient follow-up. Hormonal therapy combined with immunoglobulins did not lead to improvement, and there was rapid progression of the lung lesions. Subsequently, the patient underwent a surgery, the diseased tissue was separated and removed completely beside the left submandibular gland under local anaesthesia. The immunohistochemical staining indicated CD31 (+) and CD34 (+) confirming a diagnosis of metastatic angiosarcoma. The expression of PD-L1 was 70%, therefore, anlotinib and pembrolizumab treatments were initiated. The patient eventually died. Conclusion Angiosarcoma is a malignant tumor in the clinic that lacks typical and specific signs and symptoms. The diagnosis depends on immunohistochemistry, which requires repeated biopsies of multiple sites in highly suspected cases.
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Affiliation(s)
- Peixia Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liqian Xu
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunmei Yang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Blanco Jimenez J, Aftab G, Ngo DQ. Metastatic Cutaneous Angiosarcoma: A Rare Entity. Cureus 2021; 13:e14577. [PMID: 34035999 PMCID: PMC8135628 DOI: 10.7759/cureus.14577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We present a case of a 56-year-old female presented with a chief complaint of four months of dyspnea that had acutely worsened. The patient also reported a chronic right thigh wound. Chest radiograph on initial presentation demonstrated multiple bilateral rounded opacities. CT pulmonary angiogram demonstrated multiple bilateral rounded nodules seen on chest radiograph along with a right upper lobe pulmonary artery with near-complete compression secondary to large right hilar adenopathy. CT of right lower extremity showed evidence of ulceration with multiple conglomerate subcutaneous masses, predominately anteriorly and laterally. She underwent a bronchoscopy; a fine-needle aspiration of the subcarinal lymph node was taken. A surgical biopsy from the right thigh wound was also performed. A histological examination from the right thigh ulcer and subcarinal lymph node demonstrated high-grade spindle cell neoplasm, positive for CD-31 and consistent with angiosarcoma.
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Affiliation(s)
| | - Ghulam Aftab
- Pulmonary Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Dallis Q Ngo
- Pulmonary Medicine, Saint Peter's University Hospital, New Brunswick, USA
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15
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Mizuno T, Tomita N, Takaoka T, Tomida M, Fukuma H, Tsuchiya T, Shibamoto Y. Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp. Technol Cancer Res Treat 2021; 20:1533033820985866. [PMID: 33517860 PMCID: PMC7871283 DOI: 10.1177/1533033820985866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: We compared radiotherapy plans among helical tomotherapy (HT),
volumetric-modulated arc therapy (VMAT), and intensity-modulated proton
therapy (IMPT) for angiosarcoma of the scalp (AS). Methods: We conducted a planning study for 19 patients with AS. The clinical target
volume (CTV) 1 and CTV2 were defined as the gross tumor volume with a
specific margin and total scalp, respectively. For HT and VMAT, the planning
target volume (PTV) 1 and PTV2 were defined as CTV1 and CTV2 with 0.5-cm
margins, respectively. For IMPT, robust optimization was used instead of a
CTV-PTV margin (i.e. CTV robust). The targets of the HT and VMAT plans were
the PTV, whereas the IMPT plans targeted the CTV robust. In total, 70 Gy and
56 Gy were prescribed as the D95% (i.e. dose to 95% volume) of PTV1 (or CTV1
robust) and PTV2 (or CTV2 robust), respectively, using the simultaneous
integrated boost (SIB) technique. Other constraint goals were also defined
for the target and organs at risk (OAR). Results: All dose constraint parameters for the target and OAR met the goals within
the acceptable ranges for the 3 techniques. The coverage of the targets
replaced by D95% and D98% were almost equivalent among the 3 techniques. The
homogeneity index of PTV1 or CTV1 robust was equivalent among the 3
techniques, whereas that of PTV2 or CTV2 robust was significantly higher in
the IMPT plans than in the other plans. IMPT reduced the Dmean of the brain
and hippocampus by 49% to 95%, and the Dmax of the spinal cord, brainstem,
and optic pathway by 70% to 92% compared with the other techniques. Conclusion: The 3 techniques with SIB methods provided sufficient coverage and
satisfactory homogeneity for the targets, but IMPT achieved the best OAR
sparing.
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Affiliation(s)
- Tomoki Mizuno
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Taiki Takaoka
- Narita Memorial Proton Center, Toyohashi, Aichi, Japan
| | | | - Hiroshi Fukuma
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiro Tsuchiya
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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16
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Conic RR, Damiani G, Frigerio A, Tsai S, Bragazzi NL, Chu TW, Mesinkovska NA, Koyfman SA, Joshi NP, Budd GT, Vidimos A, Gastman BR. Incidence and outcomes of cutaneous angiosarcoma: A SEER population-based study. J Am Acad Dermatol 2020; 83:809-816. [DOI: 10.1016/j.jaad.2019.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/27/2019] [Accepted: 07/09/2019] [Indexed: 11/27/2022]
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17
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Maeda T, Kitamura S, Yanagi T. RANK-RANKL signalling pathway contributes to disease progression in cutaneous angiosarcoma: a case report with an immunohistochemical review and in vitro experiments. J Eur Acad Dermatol Venereol 2020; 34:e834-e837. [PMID: 32511804 DOI: 10.1111/jdv.16714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Maeda
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - S Kitamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - T Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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18
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Prognostic significance of positive surgical margins for scalp angiosarcoma. J Formos Med Assoc 2020; 120:217-225. [PMID: 32446755 DOI: 10.1016/j.jfma.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Scalp angiosarcomas (AS) are aggressive soft tissue sarcomas that present with outcomes different from other AS of the head and neck region. Due to the rarity of the disease, limited data on the clinical outcome of scalp AS are available. In particular, the prognostic significance of surgical margins remains controversial and the impact of margin status on survival has not been documented. METHODS We retrospectively reviewed 41 scalp AS patients, including 30 patients with localized disease and 11 patients with initial distant metastasis, treated in our institution between 1997 and 2017. Survival was determined by Kaplan-Meier analysis. In the 30 patients without distant metastasis (localized disease), univariate and multivariate analysis using the Cox proportional hazards model were used to determine clinicopathologic characteristics associated with recurrence free survival (RFS), locoregional control (LRC), and overall survival (OS). RESULTS Totally 41 patients diagnosed with scalp AS were identified, including 30 patients with localized disease and 11 patients with initial distant metastasis on diagnosis. Overall, the median follow-up period was 19.3 (range 0.3-128.5) months. The median survival time was 16.6 (range 0.3-144.3) months and the 5-year OS (95% Confidence Interval (CI)) rate was 22% (12%-42%). In the 30 patients with localized disease, univariate analysis showed that positive margins, either lateral-side or deep-side, were significant prognostic factors for RFS, LRC, and OS (p < 0.05). On multivariate analysis, positive margins emerged as adverse prognostic factors for RFS (Hazard Ratio (HR) 4.29, 95% CI, 1.71-10.75, p = 0.002), LRC (HR 6.35, 95% CI, 2.19-18.37, p = 0.001), and OS (HR 4.73, 95% CI, 1.71-13.07, p = 0.003). CONCLUSION Scalp AS is associated with high local recurrence rates and poor survival outcomes. Positive surgical margins are adverse prognostic factors for survival.
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19
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Sparber-Sauer M, Koscielniak E, Vokuhl C, Schmid I, Bien E, Seitz G, Hallmen E, von Kalle T, Scheer M, Münter M, Bielack SS, Niggli F, Ljungman G, Fuchs J, Hettmer S, Rössler J, Klingebiel T. Endothelial cell malignancies in infants, children and adolescents: Treatment results of three Cooperative Weichteilsarkom Studiengruppe (CWS) trials and one registry. Pediatr Blood Cancer 2020; 67:e28095. [PMID: 31814291 DOI: 10.1002/pbc.28095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Endothelial cell malignancies are extremely rare in childhood. New identification of genetic abnormalities (WWTR1:CAMTA1 translocation) helps to recognize potential therapeutic targets. Little is known about treatment and outcome of these patients. METHODS Clinical course, treatment, and outcome in patients with endothelial cell malignancies treated within the Cooperative Weichteilsarkom Studiengruppe (CWS) trials CWS-91, -96, -2002P, and the Soft-Tissue Sarcoma Registry (SoTiSaR) were analyzed (1991-2019). RESULTS Patients had angiosarcoma (AS) (n = 12), malignant epithelioid hemangioendothelioma (EHE) (n = 16), and kaposiform hemangioendothelioma (KHE) (n = 13). The median age was 5.39 years (range, 0.8-17.34); 33 patients had localized disease (LD), and 8 patients had metastatic disease. Therapy consisted of chemotherapy (CHT) (AS n = 8, EHE n = 9, KHE n = 5), interferon or new agent therapy (EHE n = 5, 2 KHE n = 2), microscopically or macroscopically complete resection (AS n = 3, EHE n = 6, KHE n = 3), and radiotherapy (AS n = 6, EHE n = 2, KHE n = 1). Two patients (KHE) had watch-and-wait strategy resulting in stable disease. Complete remission (CR) was achieved in AS (10/12; 83%), EHE (10/16; 63%), and KHE (5/13; 38%). The five-year EFS and OS for patients with AS was 64% (± 29 CI 95%) and 80% (± 25, CI 95%), with EHE 62% (± 24, CI 95%) and 78% (± 23, CI 95%), with KHE 33% (± 34, CI 95%) and 92% (± 15, CI 95%), respectively. Complete resection was a significant prognostic factor for AS, LD for EHE. CONCLUSIONS Endothelial cell malignancies in childhood have a fair outcome with multimodal treatment. New treatment options are needed for metastic disease.
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Affiliation(s)
- Monika Sparber-Sauer
- Klinikum Stuttgart, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Ewa Koscielniak
- Klinikum Stuttgart, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, Children's Hospital, Tuebingen, Germany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, Kiel Pediatric Tumor Registry, Kiel, Germany
| | - Irene Schmid
- Division of Pediatric Hematology and Oncology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Ewa Bien
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Guido Seitz
- Department of Pediatric Surgery, University Children's Hospital Marburg, Marburg, Germany
| | - Erika Hallmen
- Klinikum Stuttgart, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Thekla von Kalle
- Klinikum Stuttgart, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Olgahospital, Institute of Radiology, Stuttgart, Germany
| | - Monika Scheer
- Klinikum Stuttgart, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Marc Münter
- Klinikum Stuttgart, Institute of Radiotherapy, Stuttgart, Germany
| | - Stefan S Bielack
- Klinikum Stuttgart, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, University of Zurich, Zurich, Switzerland
| | - Gustaf Ljungman
- Department of Women's and Children`s Health, University of Uppsala, Children's University Hospital, Uppsala, Sweden
| | - Joerg Fuchs
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tuebingen, Germany
| | - Simone Hettmer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Germany
| | - Jochen Rössler
- Universitätsklinik für Kinderheilkunde, Hämatologie und Onkologie, Inselspital, Universitätsspital Bern, Switzerland
| | - Thomas Klingebiel
- Department for Children and Adolescents, University of Frankfurt, Frankfurt am Main, Germany
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20
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Herrscher H, Bronnec M, Antoni D, Ghnassia JP, Magnenet P, Kurtz JE, Noël G. Successful treatment of primary cutaneous angiosarcoma of the nose with sequential chemo- and radiotherapy. Clin Transl Radiat Oncol 2019; 21:1-4. [PMID: 31867448 PMCID: PMC6906694 DOI: 10.1016/j.ctro.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 11/09/2022] Open
Abstract
The optimal treatment of primary cutaneous angiosarcoma is considered to be surgical exision. Concurrent chemo-radiotherapy is efficient in the treatment of primary cutaneous angiosarcoma. The toxicity profile of this association is acceptable.
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Affiliation(s)
- H Herrscher
- Oncology Department, ICANS Comprehensive Cancer Center, 17, rue Albert Calmette, F-67200 Strasbourg, France
| | - M Bronnec
- Physic Department, ICANS Comprehensive Cancer Center, 17, rue Albert Calmette, F-67200 Strasbourg, France
| | - D Antoni
- Radiotherapy Department, ICANS Comprehensive Cancer Center, 17, rue Albert Calmette, F-67200 Strasbourg, France.,Strasbourg University, CNRS, IPHC UMR 7178, Centre Paul Strauss, UNICANCER, F-67000 Strasbourg, France
| | - J-P Ghnassia
- Pathology Department, Paul Strauss Comprehensive Cancer Center, 3, rue de la porte de l'hôpital, F-67065 Strasbourg, France
| | - P Magnenet
- Physic Department, ICANS Comprehensive Cancer Center, 17, rue Albert Calmette, F-67200 Strasbourg, France
| | - J-E Kurtz
- Oncology Department, ICANS Comprehensive Cancer Center, 17, rue Albert Calmette, F-67200 Strasbourg, France
| | - G Noël
- Radiotherapy Department, ICANS Comprehensive Cancer Center, 17, rue Albert Calmette, F-67200 Strasbourg, France.,Strasbourg University, CNRS, IPHC UMR 7178, Centre Paul Strauss, UNICANCER, F-67000 Strasbourg, France
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21
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Zhang Y, Yan Y, Zhu M, Chen C, Lu N, Qi F, Liu J. Clinical outcomes in primary scalp angiosarcoma. Oncol Lett 2019; 18:5091-5096. [PMID: 31612020 PMCID: PMC6781493 DOI: 10.3892/ol.2019.10886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
Scalp angiosarcoma is a rare, extremely aggressive cutaneous malignancy with poor patient prognosis. The present study reviewed the cases of 42 patients who presented scalp angiosarcoma and were treated at the Zhongshan Hospital of Fudan University between January 2002 and December 2013. The clinical characteristics, demographics, treatment regimens and outcomes of patients were analyzed, and the overall survival (OS) and recurrence-free survival (RFS) rates were calculated. A total of 42 patients were examined in this study. Surgery was the most common therapeutic measure, and was performed in 39 patients, alone (12 patients), in combination with chemotherapy (14 patients), radiotherapy (6 patients) or 3-modality-therapy (7 patients). The median follow-up time of patients was 28.5 months. The 5-year OS rate was 19%, and the 5-year RFS rate was 10%. Taken together, the results of the present study suggested that patients whose tumor presented a nodular localized lesion had a significantly improved OS rate (P=0.0078). Patients aged ≥70 years were associated with a lower 5-year OS (P=0.0071) and RFS rates (P=0.0095) vs. patients aged <70 years. Different treatments were not identified to be significantly associated with an improved OS or RFS. The present results also indicated that if the tumor presented nodular localized lesions, the patients exhibited a better prognosis than those with a diffuse lesion. Although younger patients had better clinical outcomes, the likelihood of recurrence and mortality remained high for all patients.
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Affiliation(s)
- Yong Zhang
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Yanwen Yan
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Ming Zhu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Cheng Chen
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Nanhang Lu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Fazhi Qi
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Jiaqi Liu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
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22
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Ihara H, Kaji T, Katsui K, Miyake T, Waki T, Katayama N, Matsuzaki H, Yamasaki O, Kuroda M, Morizane S, Kanazawa S. Single institutional experience of radiation therapy for angiosarcoma of the scalp without cervical lymph node metastases: Impact of concurrent chemoradiation with maintenance chemotherapy using taxanes on patient prognosis. Mol Clin Oncol 2019; 11:498-504. [PMID: 31620281 DOI: 10.3892/mco.2019.1918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/10/2019] [Indexed: 11/05/2022] Open
Abstract
Cutaneous angiosarcoma is a rare aggressive malignant tumor. Concurrent chemoradiation (CCRT) with maintenance chemotherapy using taxanes is one of the primary treatments. The aim of the present study was to retrospectively analyze the efficacy of CCRT with maintenance chemotherapy using taxanes in localized angiosarcoma of the scalp without cervical lymph node metastases. A total of 19 patients treated with radiation therapy for localized angiosarcomas of the scalp without cervical lymph node metastases were enrolled. The overall survival (OS), progression-free survival (PFS), and local control (LC) rates were calculated using Kaplan-Meier analysis. Univariate analyses were performed for various potential prognostic factors for OS, PFS, and LC. The median radiation dose was 70 Gy (range, 60-70 Gy), and the fractional dose was 2 Gy. Radiation therapy alone, radiation therapy + interleukin-2, surgery + CCRT with maintenance chemotherapy, CCRT with maintenance chemotherapy, and CCRT without maintenance chemotherapy were administered to 2, 4, 2, 9 and 2 patients, respectively. The 1- and 3-year OS, PFS, and LC rates were 88 and 52%, 47 and 33%, and 74 and 56%, respectively. CCRT with maintenance chemotherapy and surgery were significant prognostic factors for PFS (P=0.036 and 0.025, respectively). Therefore, CCRT with maintenance chemotherapy using taxanes might be effective in treating localized angiosarcomas of the scalp without cervical lymph node metastases.
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Affiliation(s)
- Hiroki Ihara
- Department of Radiology, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
| | - Tatsuya Kaji
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tomoko Miyake
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
| | - Norihisa Katayama
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hidenobu Matsuzaki
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan
| | - Shin Morizane
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
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23
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Chou PY, Kao D, Denadai R, Huang CY, Lin CH, Lin CH. Anterolateral thigh free flaps for the reconstruction of scalp angiosarcoma - 18-year experience in Chang Gung memorial hospital. J Plast Reconstr Aesthet Surg 2019; 72:1900-1908. [PMID: 31519502 DOI: 10.1016/j.bjps.2019.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Scalp angiosarcoma is a rare and highly aggressive cutaneous malignancy with poor prognosis and high recurrence rate. Multimodality approach is currently the treatment protocol for resectable angiosarcoma, including wide local excision and postoperative radiation. This single-institution study reviews the 18-year experience of the surgical treatment of scalp angiosarcomas. METHODS A retrospective chart review was performed on patients with scalp angiosarcoma who received wide local excision and free flap reconstruction from 2001 to 2018. The type of free flap, safety margin, outer cortex burring, and dose for radiation were recorded. Kaplan-Meier plots were computed. RESULTS Eight male patients (mean age of 74.4 years old) were enrolled in the series. Tumor sizes ranged from 3 × 3 to 8 × 13 cm. All patients underwent wide local excision and outer cortex burring (cortical curettage). Seven (87.5%) scalp defects were reconstructed with anterolateral thigh free flap. All patients received adjuvant radiation therapy for tumor bed and margins. Chemotherapy was adopted for the management of local recurrence (37.5%) or distant metastasis (37.5%). The 2-year and 5-year survival rates are 72.9% and 38.9%, respectively, and 1-year and 2-year disease-free rates are 37.5% each. CONCLUSION Scalp angiosarcoma is a rare and highly aggressive cutaneous malignancy with poor prognosis. Anterolateral thigh free flap is a good reconstructive option due to its ability to cover large cutaneous defects with minimal need for skin grafting. Multimodal treatment protocol, including wide local excision with cortical curettage, and adjuvant radiation (regular basis) and chemotherapy (local recurrence or distant metastasis) may offer improved 1-year survival rate (100%).
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Affiliation(s)
- Pang-Yun Chou
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Dennis Kao
- Plastic Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Rafael Denadai
- Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chu-Yen Huang
- Surgery Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
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24
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Abstract
This article reviews the most common nonmelanoma skin cancers affecting the head and neck region. Although the most common of these malignancies rarely result in mortality, local morbidity caused by the tumors and their extirpation cannot be underestimated. Complete tumor extirpation with pathologically confirmed negative margins is the gold standard. Regional and distant metastases are rare, but must be treated appropriately should they occur. Although reconstructive surgery can be life changing for the patients and rewarding for the clinicians, it behooves the treating surgeons to remain true to oncologic principles above all else.
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Affiliation(s)
- Michael G Brandt
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Toronto, 190 Elizabeth Street, Room 3S-438, TGH RFE Building, Toronto, Ontario M5G 2C4, Canada.
| | - Corey C Moore
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine, Western University, St Joseph's Hospital, 268 Grosvenor Street 2nd Floor, London, Ontario N6A 4V2, Canada
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Dendritic cell vaccination plus low-dose doxorubicin for the treatment of spontaneous canine hemangiosarcoma. Cancer Gene Ther 2019; 26:282-291. [PMID: 30670791 PMCID: PMC6760631 DOI: 10.1038/s41417-019-0080-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/16/2018] [Indexed: 12/13/2022]
Abstract
Angiosarcoma is a deadly neoplasm of the vascular endothelium. Metastatic disease is often present at diagnosis, and 5-year survival is only 10–35%. Although there exist no immunocompetent mouse models of angiosarcoma with which to study immune-based approaches to therapy, angiosarcoma is a major killer of companion dogs, responsible for up to 2% of all canine deaths in some susceptible breeds or an estimated 120,000 per year in the US. The canine disease (HSA) often presents in the spleen as acute hemoabdomen secondary to splenic rupture. Even if life-saving splenectomy is performed, median overall survival (OS) is only 48 days, and 1-year survival is negligible. Here we report the analysis of a pilot phase I open-label trial of chemo-immunotherapy performed on consecutively presenting splenectomized canines with histologically verified HSA. Subjects received an abbreviated course of low-dose doxorubicin plus alpha interferon and an autologous dendritic cell-therapy reported to enhance durable CD8+ memory. Disease was monitored monthly by abdominal ultrasound, chest X-ray, and echocardiogram. Median OS in the per protocol population was 109 days including one of five animals that died cancer-free at 16 months after documented resolution of relapsed disease. These results indicate that therapeutic administration of chemo-immunotherapy is both feasible and safe, substantiating the rationale for additional veterinary and human clinical studies.
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Lazaridou M, Bourlidou E, Vafeiadou M, Papadiochos Y, Barbetakis N, Kiziridou A, Mangoudi D. Malignant peripheral nerve sheath tumor (MPNST) arising from angiosarcoma: a rare case report. Oral Maxillofac Surg 2019; 23:109-112. [PMID: 30617438 DOI: 10.1007/s10006-018-0740-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE An extremely rare case of divergent differentiation of a cutaneous angiosarcoma to a malignant peripheral nerve sheath tumor (MPNST) is presented. METHODS A 62-year-old male patient presented with an angiosarcoma of the left buccal region, which was excised with wide surgical margins. Four months after the operation, the tumor recurred locally as a MPNST. The recurrent tumor was treated with surgical excision followed by postoperative radiotherapy. Four years later, the patient presented with solitary lung metastasis. The patient underwent upper right lobectomy. RESULTS The patient is alive and disease-free 2 years after the lobectomy and 6 years after initial presentation. CONCLUSIONS Divergent differentiation of an angiosarcoma to a neurosarcoma supports the theory that cells of the neural crest capable of differentiating both to neuroectoderm and to mesenchyme give origin to these tumors.
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Affiliation(s)
| | | | | | | | - Nikolaos Barbetakis
- Department of Thoracic Surgery, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | | | - Doxa Mangoudi
- Department of Oral and Maxillofacial Surgery "Theagenio" Cancer Hospital (Former), "Theagenio" Cancer Hospital, Thessaloniki, Greece
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Kaposi Sarcoma and Cutaneous Angiosarcoma: Guidelines for Diagnosis and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Requena C, Alsina M, Morgado-Carrasco D, Cruz J, Sanmartín O, Serra-Guillén C, Llombart B. Kaposi Sarcoma and Cutaneous Angiosarcoma: Guidelines for Diagnosis and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:878-887. [PMID: 30262126 DOI: 10.1016/j.ad.2018.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022] Open
Abstract
Kaposi sarcoma is a vascular sarcoma with 4 clinical variants: classic Kaposi sarcoma, which mainly affect the extremities of elderly patients and follows a chronic, generally indolent course; African Kaposi sarcoma; immunosuppression-associated Kaposi sarcoma; and AIDS-associated Kaposi sarcoma. Type8 human herpesvirus is the etiologic agent in all 4variants. Cutaneous angiosarcoma is a cutaneous neoplasm with a very poor prognosis. It carries a high probability of local relapse and has a 10% to 15% survival rate at 5years. There are 3 main variants of cutaneous angiosarcoma: idiopathic angiosarcoma of the face and scalp; Stewart-Treves syndrome; and postradiation angiosarcoma. The only potentially curative treatment is surgery with or without radiotherapy. However, its indistinct borders and multicentric nature mean that treatment is often palliative with chemotherapy, radiotherapy, or both.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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Prodinger CM, Koller J, Laimer M. Scalp tumors. J Dtsch Dermatol Ges 2018; 16:730-753. [DOI: 10.1111/ddg.13546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Christine Maria Prodinger
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Josef Koller
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Martin Laimer
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
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Recurrent Cutaneous Angiosarcoma of the Scalp With Aberrant Expression of S100: A Case Report. Am J Dermatopathol 2018; 40:419-422. [DOI: 10.1097/dad.0000000000000897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Prodinger CM, Koller J, Laimer M. Tumoren der Kopfhaut. J Dtsch Dermatol Ges 2018; 16:730-754. [DOI: 10.1111/ddg.13546_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Maria Prodinger
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Josef Koller
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
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Investigation of Prognostic Features in Primary Cutaneous and Soft Tissue Angiosarcoma After Surgical Resection: A Retrospective Study. Ann Plast Surg 2017; 78:S41-S46. [PMID: 28118230 DOI: 10.1097/sap.0000000000001004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Primary cutaneous and soft tissue angiosarcoma is a rare but highly aggressive malignancy. To date, surgical resection is the mainstay of treatment, but poor prognosis is expected. To investigate whether there are factors associated with poor prognosis after surgical resection and to develop a treatment guideline for current therapy, we retrospectively collected data on 28 patients who underwent surgery as initial treatment and reviewed patient demographics, tumor characteristics, disease courses, and prognoses from September 1996 to May 2013. Of these 28 patients, 17 (60.7%) were men and the mean age at first diagnosis was 66.57 ± 18.57 years. Anatomically, 17 (60.7%) tumors were in the scalp and 11 (39.3%) were in other sites of the body. Of the 28 patients, 23 (82.1%) had achieved negative surgical margins, 24 (85.7%) received adjuvant radiation therapy, and 17 (60.7%) received adjuvant chemotherapy. Twenty-one patients (75%) died during a mean follow-up time of 35.86 ± 28.91 months, and all deaths were caused by angiosarcoma. The 5-year overall survival rate was 17.86%. Sixteen (57.1%) patients had locoregional tumor recurrence, and 20 (71.4%) had distant metastases, with a median of 9.17 (range, 1.9-98.07) months to recurrence or metastasis. Possible predictors of poor prognosis (P < 0.05) in terms of disease-free survival after surgical resection were male sex, cardiovascular disease, smoking, and scalp angiosarcomas, those in terms of overall survival were older than 70 years, male sex, cardiovascular disease, smoking, scalp angiosarcomas, distant metastases, and not receiving adjuvant chemotherapy. In conclusion, although multimodal treatments are used, the overall prognosis after surgical resection is still poor, especially for patients with the above predictive factors. An early diagnosis and complete resection of the primary tumor with or without adjuvant radiotherapy and chemotherapy are suggested for a potential better outcome. For those who have a diffuse lesion pattern with the involvement of vital structures, recurrence, or metastasis, palliative resection could be an alternative treatment choice.
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Malignant Peripheral Nerve Sheath Tumor of the Inguinum and Angiosarcoma of the Scalp in a Child with Neurofibromatosis Type 1. Case Rep Pathol 2017; 2017:7542825. [PMID: 29138703 PMCID: PMC5613689 DOI: 10.1155/2017/7542825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
Benign and malignant tumors are common in the setting of neurofibromatosis type 1 (NF1). Malignant peripheral nerve sheath tumor (MPNST) and angiosarcoma are rare tumors in children and adolescents and mostly occur in young patients in relation to NF1. Both histological types can be present in the same tumor mass in patients with NF1. We present a case of 12.5-year-old girl with NF1 who first presented with MPNST of the right inguinal region and 1.5 years later with unrelated angiosarcoma of the scalp.
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Primary diagnosis of angiosarcoma by fine needle aspiration: Lessons learned from 3 cases. Diagn Cytopathol 2017; 46:349-354. [DOI: 10.1002/dc.23853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 12/27/2022]
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Cook JC, Obert LA, Koza-Taylor P, Coskran TM, Opsahl AC, Ziemek D, Roy M, Qian J, Lawton MP, Criswell KA. From the Cover: Fenretinide, Troglitazone, and Elmiron Add to Weight of Evidence Support for Hemangiosarcoma Mode-of-Action From Studies in Mice. Toxicol Sci 2017; 161:58-75. [DOI: 10.1093/toxsci/kfx195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shen CJ, Parzuchowski AS, Kummerlowe MN, Morris CD, Meyer CF, Habibi M, Frassica DA, Levin AS, Thornton KA, Terezakis SA. Combined modality therapy improves overall survival for angiosarcoma. Acta Oncol 2017; 56:1235-1238. [PMID: 28358642 DOI: 10.1080/0284186x.2017.1306104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Colette J. Shen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aaron S. Parzuchowski
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Megan N. Kummerlowe
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carol D. Morris
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Deborah A. Frassica
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam S. Levin
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Katherine A. Thornton
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephanie A. Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
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Trofymenko O, Curiel-Lewandrowski C. Surgical treatment associated with improved survival in patients with cutaneous angiosarcoma. J Eur Acad Dermatol Venereol 2017; 32:e29-e31. [PMID: 28710797 DOI: 10.1111/jdv.14479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- O Trofymenko
- University of Arizona College of Medicine, Tucson, 85724, Arizona, USA
| | - C Curiel-Lewandrowski
- Department of Dermatology, University of Arizona College of Medicine, Tucson, 85724, Arizona, USA
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Sindhu S, Gimber LH, Cranmer L, McBride A, Kraft AS. Angiosarcoma treated successfully with anti-PD-1 therapy - a case report. J Immunother Cancer 2017; 5:58. [PMID: 28716069 PMCID: PMC5514460 DOI: 10.1186/s40425-017-0263-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 07/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background Angiosarcomas are tumors of malignant endothelial origin that have a poor prognosis with a five-year survival of less than 40%. These tumors can be found in all age groups, but are more common in older patients; with the cutaneous form most common in older white men. Combined modality therapy including surgery and radiation appears to have a better outcome than each modality alone. When metastatic, agents such as liposomal doxorubicin, paclitaxel and ifosfamide have activity but it is short-lived and not curative. Immunotherapy targeting either the PD-1 receptor or PD-L1 ligand has recently been shown to have activity in multiple cancers including melanoma, renal, and non-small lung cancer. Although these agents have been used in sarcoma therapy, their ability to treat angiosarcoma has not been reported. Case presentation Here we describe the case of a 63-year-old man who presented initially with angiosarcoma of the nose and received surgery for the primary. Over 4 years he had recurrent disease in the face and liver and was treated with nab-paclitaxel, surgery, and radioembolization, but continued to have progressive disease. His tumor was found to express PD-L1 and he received off-label pembrolizumab 2 mg/kg every 21 days for 13 cycles with marked shrinkage of his liver disease and no new facial lesions. Secondary to this therapy he developed hepatitis and has been treated with decreasing doses of prednisone. During the 8 months off therapy he has developed no new or progressive lesions. Conclusions Although occasional responses to immunotherapy have been reported for sarcomas, this case report demonstrates that angiosarcoma can express PD-L1 and have a sustained response to PD-1 directed therapy.
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Affiliation(s)
- Simran Sindhu
- Department of Medicine, Division of Hematology/Oncology, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.,The University of Arizona Cancer Center, Suite 2912, 1515 N Campbell Ave, Tucson, AZ, 85724, USA
| | - Lana H Gimber
- Department of Medical Imaging, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA
| | - Lee Cranmer
- Seattle Cancer Care Alliance, 825 Eastlake Ave, Seattle, WA, 98109, USA
| | - Ali McBride
- The University of Arizona Cancer Center, Suite 2912, 1515 N Campbell Ave, Tucson, AZ, 85724, USA
| | - Andrew S Kraft
- Department of Medicine, Division of Hematology/Oncology, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA. .,The University of Arizona Cancer Center, Suite 2912, 1515 N Campbell Ave, Tucson, AZ, 85724, USA.
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da Costa A, Bonner M, Arbiser JL. Comprehensive profiling of H-Ras signalling in angiosarcoma endothelium. Clin Exp Dermatol 2017; 42:645-647. [PMID: 28691211 DOI: 10.1111/ced.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The MS1/SVR system, in which MS1 represents immortalized endothelial cells and SVR represents MS1 cells transformed with oncogenic human-rat sarcoma protein (H-Ras), has been used for around 20 years as a valuable tool to study angiogenesis and carcinogenesis. Despite the use of these cells in numerous studies, a comprehensive profile of the signalling differences due to oncogenic H-Ras transformation has not been performed previously. In this study, we profiled the well-known MS1 and SVR cell lines using a combination of both Western blot and gene chip assays.
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Affiliation(s)
- A da Costa
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - M Bonner
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - J L Arbiser
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Ertekin SS, Ozkur E, Leblebici C, Gürel MS, Erdemir AVT. Cutaneous Angiosarcoma Mimicking Panniculitis in the Lower Extremities. Indian J Dermatol 2017; 62:322-324. [PMID: 28584381 PMCID: PMC5448273 DOI: 10.4103/ijd.ijd_392_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sumeyre Seda Ertekin
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey. E-mail:
| | - Ezgi Ozkur
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey. E-mail:
| | - Cem Leblebici
- Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Salih Gürel
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey. E-mail:
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Wegner CD, Goodwin A, Cook JC, Allamneni K, Sohn J, McVean M. Why Do Promising Therapies Stall in Development and How Can We Move Them Forward? Int J Toxicol 2017; 36:340-349. [PMID: 28578602 DOI: 10.1177/1091581817709773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are many reasons that molecules fail to progress to market and various principles of risk-benefit decisions that can help drive the molecule through development. This symposium included discussions on global strategies involved in pushing promising molecules to market, what to do when a molecule stalls in its progress to market, and options for rescuing the molecule and pushing it forward again. Innovative partnerships that bring stalled drugs back into clinical development were also addressed. A regulatory perspective on common reasons for a molecule to fail in its forward progress was presented. In addition, situations arise when a third-party advisory committee can provide input to help overcome issues identified by a regulatory agency. Using examples from the private and public domain, presentations centered on how to repurpose a molecule and when more science is needed.
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Affiliation(s)
- Craig D Wegner
- 1 AstraZeneca Pharmaceuticals, IMED Biotech Unit, Waltham, MA, USA
| | - Andrew Goodwin
- 2 US Food and Drug Administration, Silver Spring, MD, USA
| | - Jon C Cook
- 3 Pfizer Worldwide Research and Development, Groton, CT, USA
| | | | - Jane Sohn
- 2 US Food and Drug Administration, Silver Spring, MD, USA
| | - Maralee McVean
- 5 PreClinical Research Services, Inc, Fort Collins, CO, USA
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Requena C, Sendra E, Llombart B, Sanmartín O, Guillén C, Lavernia J, Traves V, Cruz J. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Requena C, Sendra E, Llombart B, Sanmartín O, Guillén C, Lavernia J, Traves V, Cruz J. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:457-465. [PMID: 28318524 DOI: 10.1016/j.ad.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Primary cutaneous angiosarcoma is one of the most aggressive skin tumors and carries a very poor prognosis. Its initially indolent clinical presentation explains the frequently late diagnosis that, together with its typically multifocal pattern and poor delimitation, often makes surgery difficult. The low incidence of primary cutaneous angiosarcoma means that few large single-center series have been published. We review the clinical and pathologic characteristics of cutaneous angiosarcomas treated in our hospital, looking for prognostic factors and for possible diagnostic traits that could facilitate early diagnosis. MATERIAL AND METHODS This was a retrospective observational study including all patients diagnosed with cutaneous angiosarcoma in Instituto Valenciano de Oncología in Valencia, Spain between January 2000 and December 2015. We recorded 16 clinical parameters, including age, sex, type of angiosarcoma, site, size, and time since diagnosis, and 8 histopathologic parameters. RESULTS We identified 16 patients (11 women and 5 men) with cutaneous angiosarcoma. Their mean age was 67 years (median, 71 years). The most common site was the trunk (10 cases), followed by the head and neck (5 cases). The mean size of the tumor was 10cm (median, 6.5cm). Fourteen patients underwent surgical excision. Six of the 16 patients were alive at the end of the study, after a mean follow-up period of 42.5 months. CONCLUSIONS The major determinants of survival among patients with cutaneous angiosarcoma are tumor size and patient age. Other characteristics associated with a poor prognosis were infiltration of deep planes (muscle), a predominantly solid histologic pattern, and a larger number of mitoses.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - E Sendra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J Lavernia
- Servicio de Oncología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
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Ostheimer C, Hübsch P, Janich M, Gerlach R, Vordermark D. Dosimetric comparison of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in total scalp irradiation: a single institutional experience. Radiat Oncol J 2016; 34:313-321. [PMID: 27951625 PMCID: PMC5207369 DOI: 10.3857/roj.2016.01935] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/22/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). MATERIALS AND METHODS A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. RESULTS VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8% -88.4% in coplanar, 77.5%-88.2% in non-coplanar IMRT and 82.8%-90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). CONCLUSION Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue.
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Affiliation(s)
- Christian Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Patrick Hübsch
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Martin Janich
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Reinhard Gerlach
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
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Shimizu A, Kaira K, Okubo Y, Utsumi D, Yasuda M, Asao T, Nishiyama M, Takahashi K, Ishikawa O. Positive PD-L1 Expression Predicts Worse Outcome in Cutaneous Angiosarcoma. J Glob Oncol 2016; 3:360-369. [PMID: 28831444 PMCID: PMC5560454 DOI: 10.1200/jgo.2016.005843] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose Programmed death-1 (PD-1) or programmed death ligand-1 (PD-L1) targeted therapies have shown promising survival outcomes in several human neoplasms. However, it is unclear whether the expression of PD-L1 can be correlated to any clinical and pathologic variables in patients with cutaneous angiosarcoma (CA). The aim of this study was to evaluate the clinicopathological significance of PD-L1 expression in CA patients. Materials and Methods Data from 52 patients with CA were retrospectively reviewed. PD-L1 expression, tumor proliferation determined by Ki-67 index, and immunohistochemical evaluation of tumor-infiltrating lymphocytes, CD4+ and CD8+, were used to determine correlation with clinicopathological variables. Results PD-L1 was positively expressed in 40% of all patients. PD-L1 expression was significantly associated with tumor cell proliferation. Multivariate analysis confirmed that high levels of CD8+ tumor-infiltrating lymphocytes were a significant predictor in patients with clinical stage I CA and the positive expression of PD-L1 was an independent prognostic factor in predicting worse outcome. Conclusion PD-L1 expression is a novel pathologic marker for predicting worse outcome in patients with CA.
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Affiliation(s)
- Akira Shimizu
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Kyoichi Kaira
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yuko Okubo
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Daisuke Utsumi
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Masahito Yasuda
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Takayuki Asao
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Masahiko Nishiyama
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Kenzo Takahashi
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Osamu Ishikawa
- and Gunma University Graduate School of Medicine, Maebashi, Gunma; and and Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
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48
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Pencik J, Pham HTT, Schmoellerl J, Javaheri T, Schlederer M, Culig Z, Merkel O, Moriggl R, Grebien F, Kenner L. JAK-STAT signaling in cancer: From cytokines to non-coding genome. Cytokine 2016; 87:26-36. [PMID: 27349799 DOI: 10.1016/j.cyto.2016.06.017] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/15/2016] [Indexed: 12/13/2022]
Abstract
In the past decades, studies of the Janus kinases (JAKs) and signal transducers and activators of transcription (STATs) signaling have uncovered highly conserved programs linking cytokine signaling to the regulation of essential cellular mechanisms such as proliferation, invasion, survival, inflammation and immunity. Inhibitors of the JAK/STAT pathway are used for treatment of autoimmune diseases, such as rheumatoid arthritis or psoriasis. Aberrant JAK/STAT signaling has been identified to contribute to cancer progression and metastatic development. Targeting of JAK/STAT pathway is currently one of the most promising therapeutic strategies in prostate cancer (PCa), hematopoietic malignancies and sarcomas. Notably, newly identified regulators of JAK/STAT signaling, the non-coding RNAs transcripts and their role as important targets and potential clinical biomarkers are highlighted in this review. In addition to the established role of the JAK/STAT signaling pathway in traditional cytokine signaling the non-coding RNAs add yet another layer of hidden regulation and function. Understanding the crosstalk of non-coding RNA with JAK/STAT signaling in cancer is of critical importance and may result in better patient stratification not only in terms of prognosis but also in the context of therapy.
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Affiliation(s)
- Jan Pencik
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria.
| | - Ha Thi Thanh Pham
- Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria; Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Medical University of Vienna, 1210 Vienna, Austria
| | - Johannes Schmoellerl
- Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Tahereh Javaheri
- Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria; Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Medical University of Vienna, 1210 Vienna, Austria
| | - Michaela Schlederer
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria; Department for Pathology of Laboratory Animals, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
| | - Zoran Culig
- Department of Urology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Olaf Merkel
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Richard Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria; Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Medical University of Vienna, 1210 Vienna, Austria
| | - Florian Grebien
- Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Lukas Kenner
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Cancer Research, Medical University of Vienna, 1090 Vienna, Austria; Department for Pathology of Laboratory Animals, University of Veterinary Medicine Vienna, 1210 Vienna, Austria.
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49
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Mattes MD, Zhou Y, Berry SL, Barker CA. Dosimetric comparison of axilla and groin radiotherapy techniques for high-risk and locally advanced skin cancer. Radiat Oncol J 2016; 34:145-55. [PMID: 27306779 PMCID: PMC4938352 DOI: 10.3857/roj.2015.01592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/02/2016] [Accepted: 03/10/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose: Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. Materials and Methods: Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. Results: In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung V20 (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum Dmax (13.6 vs. 38.9 Gy), bowel D200cc (7.3 vs. 23.1 Gy), femur D50 (34.6 vs. 57.2 Gy), and genitalia Dmax (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus Dmean (16.9 vs. 22.4 Gy), brachial plexus D5 (57.4 vs. 61.3 Gy), bladder D5 (26.8 vs. 36.5 Gy), and femur D50 (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. Conclusion: Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Zhou
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean L Berry
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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50
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Kak I, Salama S, Gohla G, Naqvi A, Alowami S. A Case of Patch Stage of Kaposi's Sarcoma and Discussion of the Differential Diagnosis. Rare Tumors 2016; 8:6123. [PMID: 27134709 PMCID: PMC4827646 DOI: 10.4081/rt.2016.6123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/16/2015] [Accepted: 11/28/2015] [Indexed: 12/03/2022] Open
Abstract
A 55 year old HIV positive male had a skin lesion biopsy which showed atypical vascular proliferation within the superficial and deep dermis with mild atypia of lining endothelial cells. A sparse lymphoplasmacytic infiltrate surrounding the irregular vascular channels was noted. Immunohistochemistry highlighted the atypical blood vessels with the vascular markers CD31, CD34 and Factor VIII. The differential diagnosis included unusual vascular or lymphatic proliferations, stasis dermatitis, kaposiform hemangioendothelioma, progressive lymphangioma and angiosarcoma with focal Kaposi’s sarcoma features. Characteristic human herpes virus-8 positive staining helped support the diagnosis of patch stage of Kaposi’s sarcoma. Herein, we discuss the case findings, differential diagnosis and characteristic histological findings associated with the patch stage of Kaposi’s sarcoma which can be an elusive diagnosis.
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Affiliation(s)
- Ipshita Kak
- Department of Pathology and Molecular Medicine, McMaster University , Hamilton, ON, Canada
| | - Samih Salama
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Gabriella Gohla
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Asghar Naqvi
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Salem Alowami
- Department of Pathology and Molecular Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
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