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Wu M, Papps T, Blaya-Alvarez B. Recognising angiosarcoma presenting as an enlarging ecchymotic plaque. BMJ Case Rep 2024; 17:e258751. [PMID: 39266028 DOI: 10.1136/bcr-2023-258751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
Cutaneous angiosarcoma (cAS) is a rare malignant neoplasm of vascular endothelial origin with an unfavourable prognosis. Its diagnosis often faces delays due to its manifestation as an inconspicuous 'bruise-like' lesion in an otherwise asymptomatic individual, leading to a generally low index of suspicion for angiosarcoma. Here, we present a case of a man who presented to his general practitioner with an ecchymotic plaque on his forehead, initially thought to be benign. Over the subsequent 6 weeks, the lesion progressively enlarged and became ulcerated, prompting the patient to represent to his general practitioner. He was urgently referred to a dermatologist and a subsequent biopsy confirmed the diagnosis of cAS. Our presentation of this case serves as a reminder for physicians to maintain a high index of suspicion and low threshold for biopsy for patients with atraumatic ecchymotic lesions.
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Affiliation(s)
- Michelle Wu
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Theone Papps
- The Skin Hospital, Darlinghurst, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Bruno Blaya-Alvarez
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The Skin Hospital, Darlinghurst, New South Wales, Australia
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2
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Radaelli S, Merlini A, Khan M, Gronchi A. Progress in histology specific treatments in soft tissue sarcoma. Expert Rev Anticancer Ther 2024; 24:845-868. [PMID: 39099398 DOI: 10.1080/14737140.2024.2384584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Soft tissue sarcomas (STS) represent a heterogenous group of rare tumors, primarily treated with surgery. Preoperative radiotherapy is often recommended for extremity high-risk STS. Neoadjuvant chemotherapy, typically based on doxorubicin with ifosfamide, has shown efficacy in limbs and trunk wall STS. Second-line chemotherapy, commonly utilized in the metastatic setting, is mostly histology-driven. Molecular targeted agents are used across various histologies, and although the use of immunotherapy in STS is still in its early stages, there is increasing interest in exploring its potential. AREAS COVERED This article involved an extensive recent search on PubMed. It explored the current treatment landscape for localized and metastatic STS, focusing on the combined use of radiotherapy and chemotherapy for both extremity and retroperitoneal tumors, and with a particular emphasis on the most innovative histopathology driven therapeutic approaches. Additionally, ongoing clinical trials identified via clinicaltrials.gov are included. EXPERT OPINION Recently there have been advancements in the treatment of STS, largely driven by the outcomes of clinical trials. However further research is imperative to comprehend the effect of chemotherapy, targeted therapy and immunotherapy in various STS, as well as to identify biomarkers able to predict which patients are most likely to benefit from these treatments.
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Affiliation(s)
- Stefano Radaelli
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, Orbassano, Italy
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Misbah Khan
- Surgery, East Sussex NHS Healthcare, East Sussex, UK
| | - Alessandro Gronchi
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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3
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Selby LV, Clark E, Chen JL, Tinoco G, Beane JD, Pollock RE, Liebner D, Grignol VP. Use of neoadjuvant paclitaxel in breast angiosarcoma-Impact on surgical resection and response rates. J Surg Oncol 2024; 130:579-585. [PMID: 39016208 DOI: 10.1002/jso.27772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Breast angiosarcoma is a tumor that can arise as a primary breast tumor or in association with prior radiation therapy. Angiosarcomas are uniquely sensitive to paclitaxel. This study evaluated the impact neoadjuvant paclitaxel (NAC) therapy has on surgical outcomes, tumor recurrence, and survival in breast angiosarcomas. METHODS Patients with angiosarcoma of the breast, either primary or radiation-associated, were identified from a prospective institutional database. Patients receiving NAC were compared to those treated with upfront surgery. Clinical and pathological variables were compared using Student's t-test or Fisher's exact test, differences in survival were calculated using Kaplan-Meier methods. RESULTS Twenty-four patients with angiosarcoma of the breast were identified, 10 with primary angiosarcoma and 14 with radiation-associated angiosarcoma. Twelve patients received NAC, 6 of each with primary angiosarcoma or radiation-associated angiosarcoma. Of these 12 patients, 11 had a margin negative resection (91%) of which, nine had a complete pathological response on surgical pathology. Of the 12 surgery-first patients, four (n = 4/12, 33%) had positive surgical margins, two of the four underwent reoperation. With a median follow-up of 16 months, four NAC patients had recurrence (33%) compared to six patients in the surgery-first group (58%) (p = 0.41). While not statistically significant, NAC patients had a 33% less risk of recurring compared to surgery-first patients ([hazard ratio =0.67 (95% confidence interval 0.16-2.72; p = 0.6]). CONCLUSION NAC for breast angiosarcoma may be associated with high rates of complete pathological response and margin-negative resection. However, this did not impact overall survival. Future prospective control studies and longer follow-up periods are warranted to understand the impact on recurrence and survival.
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Affiliation(s)
- Luke V Selby
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, Division of Colorectal and Oncologic Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Emma Clark
- The Ohio State University School of Medicine, Ohio State University, Columbus, Ohio, USA
- Department of Surgery, Wright State University, Dayton, Ohio, USA
| | - James L Chen
- Department of Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gabriel Tinoco
- Department of Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joal D Beane
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Raphael E Pollock
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - David Liebner
- Department of Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Valerie P Grignol
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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Lim RMH, Lee JY, Kannan B, Ko TK, Chan JY. Molecular and immune pathobiology of human angiosarcoma. Biochim Biophys Acta Rev Cancer 2024; 1879:189159. [PMID: 39032539 DOI: 10.1016/j.bbcan.2024.189159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Angiosarcoma is a rare endothelial-derived malignancy that is extremely diverse in anatomy, aetiology, molecular and immune characteristics. While novel therapeutic approaches incorporating targeted agents and immunotherapy have yielded significant improvements in patient outcomes across several cancers, their impact on angiosarcoma remains modest. Contributed by its heterogeneous nature, there is currently a lack of novel drug targets in this disease entity and no reliable biomarkers that predict response to conventional treatment. This review aims to examine the molecular and immune landscape of angiosarcoma in association with its aetiology, anatomical sites, prognosis and therapeutic options. We summarise current efforts to characterise angiosarcoma subtypes based on molecular and immune profiling. Finally, we highlight promising technologies such as single-cell spatial "omics" that may further our understanding of angiosarcoma and propose strategies that can be similarly applied for the study of other rare cancers.
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Affiliation(s)
| | - Jing Yi Lee
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Bavani Kannan
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Tun Kiat Ko
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Jason Yongsheng Chan
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
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5
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Dufresne A, Lindner LH, Striefler J, Kasper B, Van Houdt W, Litiere S, Marreaud S, Blay JY, D'Ambrosio L, Stacchiotti S. The challenge of running trials in advanced angiosarcoma: A systematic review of the literature from EORTC/STBSG to guide the development of angiosarcoma-specific trials. Eur J Cancer 2024; 207:114188. [PMID: 38954898 DOI: 10.1016/j.ejca.2024.114188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION While available systemic treatments have modest long term efficacy in advanced angiosarcoma, immunotherapy represents an interesting new therapeutic opportunity. To establish its benefit, it is required to conduct a clinical trial assessing its efficacy and toxicity compared to standard treatments. MATERIAL AND METHODS This is a literature review from PubMed search. RESULTS Several systemic treatments (chemotherapy and TKI) are currently used in advanced angiosarcoma with ORR ranging from 12.5 to 68 % and PFS from 2 to 7 months. However, few randomized trials, mainly phase II, has been conducted to compare these treatments. While most centers propose doxorubicin containing regimens or paclitaxel in 1st or 2nd line, a high heterogeneity of regimens administered in this setting is observed even across sarcoma specialized centers with no consensual standard treatment. Encouraging signals of immunotherapy activity have been reported in angiosarcoma from several retrospective and phase II studies assessing anti-PD1 either alone or in combination with anti CTLA4 or TKI. Although cutaneous and head and neck location seems to benefit more from immunotherapy, response may be observed in any angiosarcoma subtype. In sarcoma in general and AS in particular, no biomarker has been clearly established to predict the efficacy of immunotherapy: high tumor mutational burden and presence of tertiary lymphoid structures are under assessment. DISCUSSION Even essential, developing a randomized clinical trial in AS struggles with the heterogeneity of the disease, the lack of consensual standard regimen, the uncertainty on optimal immunotherapy administration and the absence of established predictive biomarkers. CONCLUSION International collaboration is essential to run randomized trial in advanced AS and asses the efficacy of immune therapy in this rare and heterogeneous disease.
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Sharrack N, Parent M, Lethaby C, Rosendahl U, Lyon AR, Farooq M, Jamil H, Greenwood JP, Plein S, Kidambi A. Regression of cardiac angiosarcoma in a 17-year-old: a percutaneous biopsy effect. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:45. [PMID: 39044266 PMCID: PMC11264432 DOI: 10.1186/s40959-024-00239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Cardiac angiosarcoma is a very rare and aggressive primary cardiac tumor associated with poor prognosis. Diagnosis is often delayed due to non-specific symptoms, with most cases involving metastases at the time of diagnosis. We describe a unique case of apparent tumor regression of cardiac angiosarcoma post percutaneous biopsy. CASE PRESENTATION A young male was admitted with suspected pericarditis. Echocardiogram revealed a pericardial mass. Cardiovascular magnetic resonance (CMR) suggested primary cardiac malignancy. Percutaneous biopsy was inconclusive, with subsequent CMR demonstrating apparent tumor regression. Interval imaging revealed further tumor growth, and surgical biopsy revealed primary cardiac angiosarcoma (PCAS). Causes of tumor regression following percutaneous biopsy are discussed. CONCLUSIONS Cases of suspected primary cardiac malignancy require careful follow up with serial multimodality imaging. Percutaneous biopsy effects should be considered in cases of tumor regression, and serial imaging should be planned afterwards.
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Affiliation(s)
- Noor Sharrack
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
| | - Martine Parent
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Christopher Lethaby
- Yorkshire Regional Centre for Pediatric Oncology and Hematology, Leeds General Infirmary, Leeds, Yorkshire, UK
| | - Ulrich Rosendahl
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardio-Oncology Service, Royal Brompton Hospital, London, UK
| | - Maryum Farooq
- Department of Cardiology, Airedale NHS foundation trust, West Yorkshire, UK
| | - Haqeel Jamil
- Department of Cardiology, Airedale NHS foundation trust, West Yorkshire, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Ananth Kidambi
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, UK
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7
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Karigyo CJT, Pessoa BMS, Nicacio SP, Terwilliger E, Costa P, dos Santos PR, Ernani V, Seetharam M, Murakami AN, Batalini F. Cardiac Tumors: Review. Braz J Cardiovasc Surg 2024; 39:e20230405. [PMID: 39038269 PMCID: PMC11262154 DOI: 10.21470/1678-9741-2023-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024] Open
Abstract
Cardiac tumors are rare and encompass a variety of presentations. Clinica symptoms are usually nonspecific, but they can present as obstructive, embolic, or constitutional symptoms. Treatment options and prognosis vary highly depending on the subtype, tumor size, and location. Surgical resection is usually the first-line therapy, except for cardiac lymphomas, and provides favorable long-term prognosis in most benign tumors. Cardiac sarcomas, however, are usually diagnosed in advanced stages, and the treatment relies on a multimodal approach with chemotherapy and radiotherapy. Metastatic cardiac tumors are usually related to advanced disease and carry an overall poor prognosis.
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Affiliation(s)
- Carlos J. T. Karigyo
- Engineering Center for Circulatory Assistance, Instituto Dante
Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
- Postgraduate Program in Medicine/Technology and Intervention in
Cardiology, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
| | | | | | - Emma Terwilliger
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota,
United States of America
| | - Philippos Costa
- Division of Hematology and Oncology, Yale University Yale Cancer
Center, New Haven, Connecticut, United States of America
| | - Pedro Reck dos Santos
- Division of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix,
Arizona, United States of America
| | - Vinicius Ernani
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | - Mahesh Seetharam
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | | | - Felipe Batalini
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
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8
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Campbell SR, Wooley JR, Nystrom LM. Modern Multidisciplinary Management of Soft Tissue Sarcoma of the Extremity and Trunk. JCO Oncol Pract 2024; 20:907-914. [PMID: 38574314 DOI: 10.1200/op.23.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Soft tissue sarcomas (STS) of the extremity and trunk are heterogeneous and rare tumors that require coordinated multidisciplinary management. Surgical resection remains the backbone of treatment for localized tumors, with the addition of radiotherapy to surgery to achieve high rates of local control. Despite this, overall survival is limited because of significant distant metastatic risk and a lack of efficacious systemic therapies. Clinical trials have produced conflicting results on the impact of systemic therapy in the neoadjuvant and adjuvant settings for patients with localized disease, leaving systemic treatment decisions largely guided by shared decision making and prognostic prediction tools such as nomograms. This article will review the foundational data as well as latest developments in surgical, radiotherapy, and systemic management supporting current practice guidelines for localized STS of the extremity and trunk.
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Affiliation(s)
| | - Joseph R Wooley
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH
| | - Lukas M Nystrom
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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Arai S, Igarashi T, Goto H, Kashima K, Sasaki T, Sakaguchi M, Fukushima N, Fujii H, Nishino H, Ito M, Kanazawa T. Clinical course and vascular endothelial growth factor signaling system expression in maxillary angiosarcoma: A case report. Sci Prog 2024; 107:368504241274022. [PMID: 39196593 PMCID: PMC11363231 DOI: 10.1177/00368504241274022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Maxillary angiosarcoma, an aggressive tumor derived from vascular endothelial cells, is very rare. Recently, antivascular endothelial growth factor (VEGF) therapies have attracted considerable attention. We describe the clinical course of a patient with maxillary angiosarcoma and discuss the expression of VEGF signaling molecules assessed via immunohistological analysis. An 81-year-old man presented with an aggressive tumor in the left maxillary sinus. Biopsy revealed atypical nuclear cell proliferation, and the tumor was suspected to be a sarcoma. The maxillary malignancy was treated using a multidisciplinary approach with a combination of surgery, radiotherapy, and regional chemotherapy. Examination of the specimen obtained in the first surgery revealed maxillary angiosarcoma, found to be positive for CD31, while negative for CD34, D2-40, and factor Ⅷ. Although no pathological residual tumor was observed after the planned wide surgery, cervical lymph node and distant metastases occurred. The patient died 24 months after the first surgery. Staining revealed VEGF receptor (VEGFR) 1, VEGFR2, phosphorylated Ak strain transforming, mitogen-activated protein kinase, and signal transducer and activator of transcription 3 positivity. Although our findings do not indicate that anti-VEGF therapy is beneficial for treating maxillary angiosarcomas, we found that VEGFR signaling pathways were activated in maxillary angiosarcomas similar to angiosarcomas originating at other sites. Herein, we report a case of maxillary angiosarcoma, focused on VEGFR and signaling pathway activation. To our knowledge, this is the first report to describe VEGFR system immunostaining findings in maxillary angiosarcoma.
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Affiliation(s)
- Shiho Arai
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Takeshi Igarashi
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hiroki Goto
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Kazutaka Kashima
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Toru Sasaki
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Mio Sakaguchi
- Department of Pathology, Jichi Medical University, Shimotsuke, Japan
| | | | - Hiroyuki Fujii
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Makoto Ito
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Takeharu Kanazawa
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, Shimotsuke, Japan
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Roohani S, Rotermund T, Ehret F, Dziodzio T, Jarosch A, Schäfer FM, Flörcken A, Wittenberg S, Zips D, Kaul D. Angiosarcoma: clinical outcomes and prognostic factors, a single-center analysis. J Cancer Res Clin Oncol 2024; 150:326. [PMID: 38914779 PMCID: PMC11196347 DOI: 10.1007/s00432-024-05835-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/04/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE This study sought to investigate oncological outcomes and prognostic factors for patients with angiosarcomas (AS). METHODS This single-center, retrospective cohort study, analyzed histopathologically confirmed AS cases. Primarily diagnosed, locally recurrent and metastatic AS were included. Overall survival (OS), local control (LC) and local progression-free survival (LPFS) were assessed by Kaplan-Meier estimator. Multivariable Cox regression analysis was performed to detect factors associated with OS and LPFS. RESULTS In total, 118 patients with a median follow-up of 6.6 months were included. The majority presented with localized disease (62.7%), followed by metastatic (31.4%) and locally recurrent (5.9%) disease. Seventy-four patients (62.7%) received surgery, of which 29 (39.2%) were treated with surgery only, 38 (51.4%) with surgery and perioperative radiotherapy or chemotherapy, and 7 (9.4%) with surgery, perioperative radiotherapy and chemotherapy. Multivariable Cox regression of OS showed a significant association with age per year (hazard ratio (HR): 1.03, p = 0.044) and metastatic disease at presentation (hazard ratio: 3.24, p = 0.015). For LPFS, age per year (HR: 1.04, p = 0.008), locally recurrent disease at presentation (HR: 5.32, p = 0.013), and metastatic disease at presentation (HR: 4.06, p = 0.009) had significant associations. Tumor size, epithelioid components, margin status, and perioperative RT and/or CTX were not significantly associated with OS or LPFS. CONCLUSION Older age and metastatic disease at initial presentation status were negatively associated with OS and LPFS. Innovative and collaborative effort is warranted to overcome the epidemiologic challenges of AS by collecting multi-institutional datasets, characterizing AS molecularly and identifying new perioperative therapies to improve patient outcomes.
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Affiliation(s)
- Siyer Roohani
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- BIH Charité (Junior) Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany.
- Partner site Berlin, a partnership between DKFZ and Charité, German Cancer Consortium (DKTK), Universitätsmedizin Berlin, Berlin, Germany.
| | - Titus Rotermund
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Partner site Berlin, a partnership between DKFZ and Charité, German Cancer Consortium (DKTK), Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Dziodzio
- BIH Charité (Junior) Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Armin Jarosch
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Frederik Maximilian Schäfer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Anne Flörcken
- Partner site Berlin, a partnership between DKFZ and Charité, German Cancer Consortium (DKTK), Universitätsmedizin Berlin, Berlin, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Silvan Wittenberg
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Partner site Berlin, a partnership between DKFZ and Charité, German Cancer Consortium (DKTK), Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Partner site Berlin, a partnership between DKFZ and Charité, German Cancer Consortium (DKTK), Universitätsmedizin Berlin, Berlin, Germany
- Health and Medical University Potsdam, Olympischer Weg 1, 14471, Potsdam, Germany
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11
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Palassini E, Baldi GG, Ciniselli CM, Gennaro M, Gronchi A, Sangalli C, Conforti F, Collini P, Frezza AM, Pellegrini I, Allajbej A, Fiore M, Morosi C, Pennacchioli E, Barisella M, Casali PG, Verderio P, De Pas T, Stacchiotti S. Outcome improvement with chemotherapy and radiotherapy in primary, localized, radiation-associated angiosarcoma of the breast region: a retrospective case series analysis. ESMO Open 2024; 9:103474. [PMID: 38833974 PMCID: PMC11179083 DOI: 10.1016/j.esmoop.2024.103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND We report on a series of consecutive patients with localized radiation-associated angiosarcoma (RAAS) of the breast region (BR) treated at two Italian sarcoma reference centers. MATERIALS AND METHODS We retrospectively reviewed all cases of primary, localized, resectable RAAS of the BR, treated at one of the two participating institutions from 2000 to 2019. Relapse-free survival (RFS) and overall survival (OS) were calculated. The prognostic role of several variables was investigated. A propensity score matched (PSM) analysis was carried out. RESULTS Eighty-four patients were retrospectively identified. Nineteen out of 84 patients (22.6%) were pretreated with an anthracycline-based regimen for previous cancer. All patients but one underwent surgery, with 37/84 (44.1%) receiving surgery alone and 46/84 (54.8%) a multimodal approach: 18/84 (21.4%) received radiation therapy (RT) and 46/84 (54.9%) received chemotherapy. An anthracycline-based regimen was used in 10/84 patients (11.9%), while a gemcitabine-based regimen was used in 33/84 (39.3%). With a median follow-up of 51 months (interquartile range: 30-126 months), 36/84 patients (42.9%) relapsed and 35/84 patients (41.7%) died (8/84, 9.5% in the lack of metastatic disease). Five-year OS and 5-year RFS were 57% [95% confidence interval (CI) 43% to 68%] and 52% (95% CI 39% to 63%), respectively. Both (neo)adjuvant RT and chemotherapy were associated with better RFS [hazard ratio (HR) 0.25, 95% CI 0.08-0.83; HR 0.45, 95% CI 0.23-0.89] with a trend towards a better OS (HR 0.51, 95% CI 0.18-1.46; HR 0.60, 95% CI 0.29-1.24). Gemcitabine-based regimens seemed to perform better (HR 4.28, 95% CI 1.29-14.14). PSM analysis retained the above results. CONCLUSIONS This retrospective study supports the use of (neo)adjuvant RT and chemotherapy, in primary, localized resectable RAAS of the BR. An effort to prospectively validate the role of (neo)adjuvant RT and chemotherapy is warranted.
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Affiliation(s)
- E Palassini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano.
| | - G G Baldi
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Prato
| | - C M Ciniselli
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - M Gennaro
- Department of Surgery, Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - A Gronchi
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - C Sangalli
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - F Conforti
- Department of Medical Oncology, IRCCS Istituto Europeo Oncologia, Milano
| | - P Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - A M Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - I Pellegrini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - A Allajbej
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - M Fiore
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - E Pennacchioli
- Department of Surgery, IRCCS Istituto Europeo Oncologia, Milano
| | - M Barisella
- Department of Pathology, ASST Fatebenefratelli Sacco, Milano
| | - P G Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano; Department of Oncology and Haemato-Oncology, Milan University, Milano
| | - P Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - T De Pas
- Department of Medical Oncology, IRCCS Istituto Europeo Oncologia, Milano
| | - S Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
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12
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Guzik GL, Mangla A. Primary hepatic angiosarcoma: Treatment options for a rare tumor. Oncoscience 2024; 11:47-48. [PMID: 38770446 PMCID: PMC11104409 DOI: 10.18632/oncoscience.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Gregory L. Guzik
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Ankit Mangla
- Department of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
- Department of Hematology and Oncology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Cleveland, OH 44106, USA
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13
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Palassini E, Baldi GG, Sulfaro S, Barisella M, Bianchi G, Campanacci D, Fiore M, Gambarotti M, Gennaro M, Morosi C, Navarria F, Palmerini E, Sangalli C, Sbaraglia M, Trama A, Asaftei S, Badalamenti G, Bertulli R, Bertuzzi AF, Biagini R, Bonadonna A, Brunello A, Callegaro D, Cananzi F, Cianchetti M, Collini P, Comandini D, Curcio A, D'Ambrosio L, De Pas T, Dei Tos AP, Ferraresi V, Ferrari A, Franchi A, Frezza AM, Fumagalli E, Ghilli M, Greto D, Grignani G, Guida M, Ibrahim T, Krengli M, Luksch R, Marrari A, Mastore M, Merlini A, Milano GM, Navarria P, Pantaleo MA, Parafioriti A, Pellegrini I, Pennacchioli E, Rastrelli M, Setola E, Tafuto S, Turano S, Valeri S, Vincenzi B, Vitolo V, Ivanescu A, Paloschi F, Casali PG, Gronchi A, Stacchiotti S. Clinical recommendations for treatment of localized angiosarcoma: A consensus paper by the Italian Sarcoma Group. Cancer Treat Rev 2024; 126:102722. [PMID: 38604052 DOI: 10.1016/j.ctrv.2024.102722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
Angiosarcoma (AS) represents a rare and aggressive vascular sarcoma, posing distinct challenges in clinical management compared to other sarcomas. While the current European Society of Medical Oncology (ESMO) clinical practice guidelines for sarcoma treatment are applicable to AS, its unique aggressiveness and diverse tumor presentations necessitate dedicated and detailed clinical recommendations, which are currently lacking. Notably, considerations regarding surgical extent, radiation therapy (RT), and neoadjuvant/adjuvant chemotherapy vary significantly in localized disease, depending on each different site of onset. Indeed, AS are one of the sarcoma types most sensitive to cytotoxic chemotherapy. Despite this, uncertainties persist regarding optimal management across different clinical presentations, highlighting the need for further investigation through clinical trials. The Italian Sarcoma Group (ISG) organized a consensus meeting on April 1st, 2023, in Castel San Pietro, Italy, bringing together Italian sarcoma experts from several disciplines and patient representatives from "Sofia nel Cuore Onlus" and the ISG patient advocacy working group. The objective was to develop specific clinical recommendations for managing localized AS within the existing framework of sarcoma clinical practice guidelines, accounting for potential practice variations among ISG institutions. The aim was to try to standardize and harmonize clinical practices, or at least highlight the open questions in the local management of the disease, to define the best evidence-based practice for the optimal approach of localized AS and generate the recommendations presented herein.
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Affiliation(s)
- Elena Palassini
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | | | | | - Marta Barisella
- Department of Pathology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giuseppe Bianchi
- Department of Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Domenico Campanacci
- Department of Surgery, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Marco Fiore
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Gambarotti
- Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Gennaro
- Department of Surgery, Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Federico Navarria
- Department of Radiation Oncology, IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Pordenone, Italy
| | - Emanuela Palmerini
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Sangalli
- Department of Radiation Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marta Sbaraglia
- Department of Pathology, Università di Padova, Padova, Italy
| | - Annalisa Trama
- Department of Edidemiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sebastian Asaftei
- Department of Pediatric Oncology, Ospedale Infantile Regina Margherita , Torino
| | - Giuseppe Badalamenti
- Department of Medical Oncology, Azienda Universitaria Policlinico Giaccone, Palermo, Italy
| | - Rossella Bertulli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alexia Francesca Bertuzzi
- Department of Medical Oncology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Roberto Biagini
- Department of Oncological Orthopedics, IRCCS Istituto Nazionale Tumori Regina Elena - Istituti Fisioterapici Ospitalieri, Roma, Italy
| | - Angela Bonadonna
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Pordenone, Italy
| | - Antonella Brunello
- Department of Medical Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Dario Callegaro
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ferdinando Cananzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Cancer Center, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Danila Comandini
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Annalisa Curcio
- Department of Surgery, Ospedale Morgagni e Pierantoni, Forlì, Italy
| | - Lorenzo D'Ambrosio
- Department of Medical Oncology, Ospedale S. Luigi, Orbassano, Torino, Italy
| | - Tommaso De Pas
- Department of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS Istituto Nazionale Tumori Regina Elena - Istituti Fisioterapici Ospitalieri, Roma, Italy
| | - Andrea Ferrari
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Franchi
- Department of Pathology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Anna Maria Frezza
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elena Fumagalli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Matteo Ghilli
- Breast Centre, Department of Oncology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniela Greto
- Department of Radiation Therapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giovanni Grignani
- Department of Medical Oncology, Azienda Ospedaliera Univerisitaria Città della Salute e della Scienza, Torino, Italy
| | - Michele Guida
- Department of Medical Oncology, IRCCS Istituto Tumori di Bari Giovanni Paolo II, Bari, Italy
| | - Toni Ibrahim
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Krengli
- Department of Radiation Therapy, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Roberto Luksch
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Marrari
- Department of Medical Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alessandra Merlini
- Department of Medical Oncology, Ospedale S. Luigi, Orbassano, Torino, Italy
| | | | - Piera Navarria
- Department of Radiation Therapy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Maria Abbondanza Pantaleo
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna', University of Bologna, Bologna, Italy
| | | | - Ilaria Pellegrini
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marco Rastrelli
- Department of Surgical Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), Università di Padova, Padova, Italy
| | - Elisabetta Setola
- Department of Medical Oncology, Istituto Europeo Oncologia, Milano, Italy
| | - Salvatore Tafuto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori G. Pascale, Napoli, Italy
| | - Salvatore Turano
- Department of Medical Oncology, Azienda Ospedaliera S.S. Annunziata, Cosenza, Italy
| | - Sergio Valeri
- Department of Surgery, Università Campus Bio-Medico, Roma, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - Viviana Vitolo
- Department of Radiation Therapy, Centro Nazionale di Adroterapia Oncologica, Fondazione CNAO, Pavia, Italy
| | | | | | - Paolo Giovanni Casali
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Stacchiotti
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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14
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Dirven I, Leclercq P, D'Hondt L, Delmotte V, Lefesvre P, Reynaert H, Vandenbroucke F, Surmont M. Primary splenic angiosarcoma: a case series of a rare oncological entity and diagnostic challenge. Acta Oncol 2024; 63:192-197. [PMID: 38619338 DOI: 10.2340/1651-226x.2023.35412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND PURPOSE Primary angiosarcoma of the spleen (PAS), an exceptionally rare and aggressive neoplasm with high metastatic risk (70%-85%), is frequently diagnosed in an advanced or metastatic stage. It presents diagnostic challenges due to its nonspecific symptomatology and resemblance to benign vascular lesions in various imaging modalities. PATIENTS AND METHODS This case series aims to clarify the diagnostic difficulties by comparing imaging characteristics (CT-scan, MRI, and [18F]FDG-PET/CT) as well as pathological findings of three PAS cases diagnosed in different stages of the diseases (localized, metastatic, and metastatic with organ failure). Furthermore, a brief review on diagnostic and therapeutic features is included. RESULTS AND INTERPRETATION We suggest [18F]FDG-PET/CT as a differentiating tool between benign and malignant splenic lesions and propose a flowchart of a diagnostic algorithm for PAS. For treatment, we advocate for early splenectomy and when systemic therapy is warranted, paclitaxel emerges as a viable first-line option. While it is crucial to acknowledge that further trial data is required to evaluate the efficacy of emerging treatment regimens, designing and conducting trials for PAS is challenging given its scarcity and aggressive behavior. Therefore case reporting remains important.
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Affiliation(s)
- Iris Dirven
- Department of Gastro-enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | | | - Lionel D'Hondt
- Department of Oncology, CHU UCL Namur site Godinne, Yvoir, Belgium
| | | | - Pierre Lefesvre
- Department of Pathology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Hendrik Reynaert
- Department of Gastro-enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Frederik Vandenbroucke
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Magali Surmont
- Department of Gastro-enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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15
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Zaheer S, Zhou AL, Gross JM, Kilic A. Unusual presentation and delayed diagnosis of cardiac angiosarcoma. J Cardiothorac Surg 2024; 19:161. [PMID: 38549142 PMCID: PMC10979550 DOI: 10.1186/s13019-024-02555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/30/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Primary cardiac angiosarcomas are very rare and present aggressively with high rates of metastasis. Given the poor prognosis, particularly once disease has spread, early diagnosis and multidisciplinary treatment is essential. CASE PRESENTATION We present the case of a 46-year-old male who presented with chest pain, intermittent fevers, and dyspnea. Workup with computed tomography scan and transesophageal echocardiography demonstrated a right atrial pseudoaneurysm. Given the concern for rupture, the patient was taken to the operating room, where resection of the pseudoaneurysm and repair using a bovine pericardial patch was performed. Histopathology report initially demonstrated perivascular lymphocyte infiltrate. Six weeks later, the patient represented with chest pain and new word finding difficulty. Workup revealed multiple solid lung, pericardial, brain, and bone nodules. Eventual biopsy of a cardiophrenic nodule demonstrated angiosarcoma, and rereview of the original pathology slides confirmed the diagnosis of primary cardiac angiosarcoma. CONCLUSIONS Primary cardiac angiosarcomas are often misdiagnosed given the rarity of these tumors, but early diagnosis and initiation of treatment is essential. The unique presentation of our case demonstrates that clinical suspicion for cardiac angiosarcoma should be maintained for spontaneous pseudoaneurysm originating from the right atrium.
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Affiliation(s)
- Salman Zaheer
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Alice L Zhou
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - John M Gross
- Bone and Soft Tissue Pathology, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower Suite 7107, Baltimore, MD, 21287, USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
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16
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Wong HH, Cojocaru E, Watkins J, James S, Aloysius T, Harrington J, Horan G, Hatcher H. Radiation-induced angiosarcoma of the breast: retrospective analysis at a regional treatment centre. Breast Cancer 2024; 31:272-282. [PMID: 38147173 DOI: 10.1007/s12282-023-01535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer. METHODS Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England. RESULTS 22 patients were identified between 2010 and 2022. Median age of diagnosis was 65 years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5 years (range 2.4-16.0)-this interval has decreased over the last 24 years (r2 = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28 months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65 months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72 years had a median OS of 45 months vs 102 months for those ≤ 72 years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086). CONCLUSION RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.
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Affiliation(s)
- Han Hsi Wong
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Elena Cojocaru
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - James Watkins
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sujil James
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Tony Aloysius
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Jennifer Harrington
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Gail Horan
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Helen Hatcher
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
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17
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Song Y, Li R, Wang L, Wang H. Case Report: A Rare Case of Primary Angiosarcoma of the Cervix with a Literature Review. Int J Womens Health 2024; 16:265-271. [PMID: 38370343 PMCID: PMC10871135 DOI: 10.2147/ijwh.s439583] [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: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Primary angiosarcomas are a rare type of soft-tissue sarcomas that originate from endothelial cells. These sarcomas can develop in any part of the body and have a poor prognosis. However, they are commonly found in the skin of elderly white men, particularly on the scalp and head region. Primary angiosarcoma of the cervix is exceptionally rare. To date, only two cases of this disease have been reported worldwide. The diagnosis of the disease is difficult microscopically, requiring immunohistochemistry and genetic testing to distinguish. We report a recent case, in which the lesion was preoperatively considered a high-grade endometrial stromal sarcoma. A 35-year-old woman presented with vaginal bleeding and cervical erosions. A high-grade endometrial stromal sarcoma involving the cervix was considered and a modified radical hysterectomy was performed with bilateral salpingo-oophorectomy and sentinel lymph nodes resection. The gene diagnosis performed by fluorescence in situ hybridization for YWHAE translocation fusion was negative excluding a YWHAE-translocated high-grade endometrial stromal sarcoma. A primary angiosarcoma of the cervix was finally diagnosed. Primary angiosarcoma of the cervix is rare, and gynecologic pathologists do not know it well, so it is easy to be wrongly considered. Immunohistochemistry and genetic testing help confirm the diagnosis.
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Affiliation(s)
- Yuelin Song
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Ruizhe Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Lifei Wang
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, People’s Republic of China
| | - Hongjing Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
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18
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Dalal S, Shan KS, Thaw Dar NN, Hussein A, Ergle A. Role of Immunotherapy in Sarcomas. Int J Mol Sci 2024; 25:1266. [PMID: 38279265 PMCID: PMC10816403 DOI: 10.3390/ijms25021266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Sarcomas are a group of malignancies of mesenchymal origin with a plethora of subtypes. Given the sheer heterogeneity of various subtypes and the rarity of the disease, the management of sarcomas has been challenging, with poor patient outcomes. Surgery, radiation therapy and chemotherapy have remained the backbone of treatment in patients with sarcoma. The introduction of immunotherapy has revolutionized the treatment of various solid and hematological malignancies. In this review, we discuss the basics of immunotherapy and the immune microenvironment in sarcomas; various modalities of immunotherapy, like immune checkpoint blockade, oncolytic viruses, cancer-targeted antibodies, vaccine therapy; and adoptive cell therapies like CAR T-cell therapy, T-cell therapy, and TCR therapy.
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Affiliation(s)
- Shivani Dalal
- Memorial Healthcare, Division of Hematology and Oncology, Pembroke Pines, FL 33028, USA; (K.S.S.); (N.N.T.D.); (A.H.); (A.E.)
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19
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Gurruchaga Sotés I, Gómez-Mateo MC, Ortega Izquierdo ME, Martínez-Trufero J. Beneficial Use of the Combination of Gemcitabine and Dacarbazine in Advanced Soft Tissue Sarcomas: Real-World Data. Cancers (Basel) 2024; 16:267. [PMID: 38254758 PMCID: PMC10813902 DOI: 10.3390/cancers16020267] [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: 12/14/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The combination of gemcitabine and dacarbazine has exhibited efficacy in terms of progression-free survival (PFS) and overall survival (OS) for aSTSs, albeit without robust confirmation from larger clinical trials. METHODS We conducted a retrospective study in a single institution involving aSTS patients treated with gemcitabine and dacarbazine. RESULTS 95 patients were assessed, pointing to a benefit in PFS of 3.5 months and an OS of 14.2 months. Patients with translocated histotypes had better PFS, while those with platelet-lymphocyte ratios (PLRs) surpassing a specific threshold or lower albumin levels had poorer overall survival. CONCLUSIONS This study validates previous findings from three phase I-II trials, affirming the utility of this treatment approach in routine clinical practice.
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Affiliation(s)
- Ibon Gurruchaga Sotés
- Department of Medical Oncology, Hospital Universitario de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain; (M.E.O.I.); (J.M.-T.)
| | - M. Carmen Gómez-Mateo
- Department of Pathology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - María Eugenia Ortega Izquierdo
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain; (M.E.O.I.); (J.M.-T.)
- Department of Medical Oncology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | - Javier Martínez-Trufero
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain; (M.E.O.I.); (J.M.-T.)
- Department of Medical Oncology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
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20
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Merlini A, Rabino M, Brusco S, Pavese V, Masci D, Sangiolo D, Bironzo P, Scagliotti GV, Novello S, D'Ambrosio L. Epigenetic determinants in soft tissue sarcomas: molecular mechanisms and therapeutic targets. Expert Opin Ther Targets 2024; 28:17-28. [PMID: 38234142 DOI: 10.1080/14728222.2024.2306344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/12/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Soft tissue sarcomas are a group of rare, mesenchymal tumors characterized by dismal prognosis in advanced/metastatic stages. Knowledge of their molecular determinants is still rather limited. However, in recent years, epigenetic regulation - the modification of gene expression/function without DNA sequence variation - has emerged as a key player both in sarcomagenesis and sarcoma progression. AREAS COVERED Herein, we describe and review the main epigenetic mechanisms involved in chromatin remodeling and their role as disease drivers in different soft tissue sarcoma histotypes, focusing on epithelioid sarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumors. Focusing on chromatin-remodeling complexes, we provide an in-depth on the role of BAF complex alterations in these soft tissue sarcoma histotypes. In parallel, we highlight current state-of-the-art and future perspectives in the development of rational, innovative treatments leveraging on epigenetic dysregulation in soft tissue sarcomas. EXPERT OPINION Therapeutic options for metastatic/advanced sarcomas are to date very limited and largely represented by cytotoxic agents, with only modest results. In the continuous attempt to find novel targets and innovative, effective drugs, epigenetic mechanisms represent an emerging and promising field of research, especially for malignant peripheral nerve sheath tumors, epithelioid and synovial sarcoma.
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Affiliation(s)
| | - Martina Rabino
- Department of Oncology, University of Turin, Orbassano (TO), Italy
| | - Silvia Brusco
- Department of Oncology, University of Turin, Orbassano (TO), Italy
- Division of Molecular Pathology, The Institute of Cancer Research Royal Cancer Hospital, London, UK
| | - Valeria Pavese
- Department of Oncology, University of Turin, Orbassano (TO), Italy
| | - Debora Masci
- Department of Oncology, University of Turin, Orbassano (TO), Italy
| | - Dario Sangiolo
- Department of Oncology, University of Turin, Orbassano (TO), Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, Orbassano (TO), Italy
- Medical Oncology, S. Luigi Gonzaga University Hospital, Orbassano (TO), Italy
| | - Giorgio Vittorio Scagliotti
- Department of Oncology, University of Turin, Orbassano (TO), Italy
- Medical Oncology, S. Luigi Gonzaga University Hospital, Orbassano (TO), Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano (TO), Italy
- Medical Oncology, S. Luigi Gonzaga University Hospital, Orbassano (TO), Italy
| | - Lorenzo D'Ambrosio
- Department of Oncology, University of Turin, Orbassano (TO), Italy
- Medical Oncology, S. Luigi Gonzaga University Hospital, Orbassano (TO), Italy
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21
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Fujimura T, Yoshino K, Nakamura M, Kato H, Ito T, Maekawa T, Fujisawa Y, Matsushita S, Amagai R, Yamazaki E, Takahashi M, Tamabuchi E, Hashimoto A, Kambayashi Y, Yamazaki N, Miyata T, Asano Y. Efficacy and safety of TM5614 in combination with paclitaxel in the treatment of paclitaxel-resistant cutaneous angiosarcoma: Phase II study protocol. Exp Dermatol 2024; 33:e14976. [PMID: 37946551 DOI: 10.1111/exd.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
Cutaneous angiosarcoma (CAS) is an endothelial cell-derived, highly aggressive type of vascular tumour. Although chemoradiotherapy with paclitaxel (PTX) is recognized as a first-line therapy for CAS, second-line therapy for CAS remains controversial, and there is no standard therapy for taxane-resistant CAS. Plasminogen activator inhibitor-1 (PAI-1) is associated with poor clinical outcomes, and elevated levels of PAI-1 in both tissue and serum are correlated with poor response to therapy in various cancers, including skin cancers. Since PAI-1 protects endothelial cells from Fas ligand-mediated apoptosis, PAI-1 inhibition might induce apoptosis of endothelial cell-derived tumours such as CAS. This is a single-arm, open-label, multi-institutional, Phase 2 clinical trial to assess the efficacy and safety of PTX in combination with TM5614 (PAI-1 inhibitor) in patients with PTX-resistant CAS. PTX will be administered for 28 weeks, with oral administration of TM5614. The primary endpoint of this study will be the overall response rate (ORR) at 28 weeks after starting treatment (central image evaluation). The secondary endpoint will include the ORR at 28 weeks after starting treatment (investigator evaluation), ORR at 8 weeks and 16 weeks after initiation of treatment (central and investigator evaluation), progression-free survival, overall survival, disease control rate and safety profiles. Assuming the null hypothesis of a response rate of 13.6% and an alternative hypothesis of 45%, a minimum of 15 patients are required to achieve a two-sided, Type I error of 5% and power of 70% based on the exact binomial distribution. Data quality control will be conducted by a combination of centralized (remote) and on-site monitoring. This study will contribute to the development of novel combination therapy for PTX-resistant CAS patients, which remains an unmet clinical need.
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Affiliation(s)
- Taku Fujimura
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Koji Yoshino
- Department of Dermato-Oncology/Dermatology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Shimotsuke, Japan
| | | | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Ryo Amagai
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Emi Yamazaki
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Manami Takahashi
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Erika Tamabuchi
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshio Miyata
- Department of Molecular Medicine and Therapy, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
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22
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Digklia A, Kollár A, Dietrich D, Kronig MN, Britschgi C, Rordorf T, Joerger M, Krasniqi F, Metaxas Y, Colombo I, Ribi K, Rothermundt C. SAKK57/16 Nab-paclitaxel and Gemcitabine in Soft Tissue Sarcoma (NAPAGE): a phase I/II trial. Eur J Cancer 2024; 197:113470. [PMID: 38096656 DOI: 10.1016/j.ejca.2023.113470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND To determine whether the combination of nab-paclitaxel with gemcitabine has activity in patients with pretreated soft tissue sarcoma (STS). PATIENTS AND METHODS NAPAGE is a phase Ib/II clinical trial investigating the combination of nab-paclitaxel (nab-pc) with gemcitabine employing two cohorts. One of a dose-de-escalation phase and one of expansion. In phase I, nab-pc was given at 150 mg/m2 in combination with gemcitabine 1000 mg/m2 every two weeks, until disease progression or unacceptable toxicity. This dose was recommended for phase II (RP2D), as there was no dose limiting toxicity (DLT) or discontinuations due to adverse events (AEs). The primary endpoint of the phase II was progression-free rate (PFR) at 3 months (H0: 20%, H1:40%). The secondary endpoints included progression free survival (PFS), overall survival (OS), AEs, objective response and patient-reported outcomes (PRO). Efficacy analysis was by intention to treat. RESULTS The 3-month PFR was 56.4% (95% confidence interval CI: 39.6-72.2%). The 3-month and 6-month PFS were 58.4% (95% CI: 41.3-72.1%) and 44.6% (95% CI: 28.4-59.5%), respectively. Median PFS was 5.3 months (95% CI: 1.4-8.2) and median OS was 12.8 months (95% CI: 10.5-39.2). The most common treatment-related grade ≥ 3 AE were neutropenia (18%), followed by anemia (2.6%), hypertension (2.6%) and alanine aminotransferase increase (2.6%). Grade 1 and grade 2 peripheral sensory neuropathy (PNP) occurred in 15.4% and 20.5%, respectively. No grade 3-4 PNP was reported. CONCLUSIONS Combining nab-pc and gemcitabine is safe. Promising activity is observed in pretreated STS patients with manageable toxicity. This regimen should be considered for further exploration.
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Affiliation(s)
- A Digklia
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - A Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Dietrich
- Swiss Group for Clinical Cancer Research (SAKK) Competence Center, Bern, Switzerland
| | - M N Kronig
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - T Rordorf
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - M Joerger
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F Krasniqi
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Y Metaxas
- Department of Medical Oncology, Cantonal Hospital, Grison Chur, Switzerland, now at Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland
| | - I Colombo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - K Ribi
- International Breast Cancer Study Group IBCSG (IBCSG), Bern, Switzerland
| | - C Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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23
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Heishima K, Aketa N, Heishima M, Kawachi A. Hemangiosarcoma in dogs as a potential non-rodent animal model for drug discovery research of angiosarcoma in humans. Front Oncol 2023; 13:1250766. [PMID: 38130992 PMCID: PMC10733437 DOI: 10.3389/fonc.2023.1250766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Since the domestication of dogs 10,000 years ago, they have shared their living environment with humans and have co-evolved. The breeding process that dogs have undergone in only a few centuries has led to a significant accumulation of specific genetic alterations that could induce particular diseases in certain breeds. These canine diseases are similar to what is found in humans with several differences; therefore, comparing such diseases occurring in humans and dogs can help discover novel disease mechanisms, pathways, and causal genetic factors. Human angiosarcoma (AS) and canine hemangiosarcoma (HSA), which are sarcomas originating from endothelium, are examples of diseases shared between humans and dogs. They exhibit similar characteristics and clinical behaviors, although with some critical differences resulting from evolution. In this review, we will describe the similarities and differences in terms of clinical and molecular characteristics between human AS and canine HSA, and discuss how these similarities and differences can be applied to advance the treatment of these diseases.
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Affiliation(s)
- Kazuki Heishima
- Institute for Advanced Study (GUiAS), Gifu University, Gifu, Japan
- Center for One Medicine Innovative Translational Research (COMIT), Gifu University, Gifu, Japan
| | - Naohiko Aketa
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | | | - Asuka Kawachi
- Division of Cancer RNA Research, National Cancer Center, Tokyo, Japan
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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24
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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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25
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Li Y, Ai Y, Tang W, Liu J, Yang J, Fan C. Case Report: Successful surgical management of a challenging primary cardiac angiosarcoma. Front Cardiovasc Med 2023; 10:1279177. [PMID: 38028439 PMCID: PMC10655095 DOI: 10.3389/fcvm.2023.1279177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Primary cardiac tumors are exceptionally rare, with malignant tumor occurrences ranging from 0.0017% to 0.28%. Among these, primary cardiac angiosarcoma (PCA) stands as the most prevalent malignancy, primarily impacting the right cardiac system. In this case report, we present the instance of a 44-year-old woman who recently exhibited acute chest discomfort and was subsequently diagnosed with a microangiosarcoma within the right atrium and superior vena cava. Diagnostic modalities including chest x-rays, CT, MRI, and PET-CT were instrumental in pinpointing the tumor's location and nature. Surgical excision followed by pathological and immunological examinations confirmed the diagnosis. The patient's recovery post-surgery has been encouraging, with successful follow-up chemoradiotherapy administered. Despite advancements, devising optimal strategies for enhancing patient survival and quality of life in angiosarcoma cases remains a pressing research challenge.
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Affiliation(s)
| | | | | | | | | | - Chengming Fan
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
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26
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Stergioula A, Kokkali S, Pantelis E. Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review. Cancer Treat Rev 2023; 120:102617. [PMID: 37603906 DOI: 10.1016/j.ctrv.2023.102617] [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: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients. METHODS The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data. RESULTS A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively. CONCLUSION Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.
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Affiliation(s)
- Anastasia Stergioula
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Center of Radiotherapy, IASO General Hospital, Athens, Greece.
| | - Stefania Kokkali
- Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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27
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Assi T, Ibrahim R, Ibrahim T, Khoury R, Cesne AL. Ipilimumab and nivolumab: the 'new kid on the block' in advanced angiosarcoma. Immunotherapy 2023; 15:1089-1091. [PMID: 37585663 DOI: 10.2217/imt-2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Tarek Assi
- Division of International Patients Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Rebecca Ibrahim
- Division of International Patients Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Toni Ibrahim
- Division of International Patients Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Rita Khoury
- Division of International Patients Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Axel Le Cesne
- Division of International Patients Care, Gustave Roussy Cancer Campus, Villejuif, France
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28
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Kim WJ, Kim HK. Current understanding of angiosarcoma: disease biology and evolving treatment. Arch Craniofac Surg 2023; 24:203-210. [PMID: 37919906 PMCID: PMC10622948 DOI: 10.7181/acfs.2023.00409] [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: 08/28/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023] Open
Abstract
Angiosarcoma is a very rare soft tissue sarcoma that originates from endothelial cells and typically has a poor prognosis. It is most commonly found in elderly white men and can occur anywhere in the body, particularly in the head, neck, and scalp. Patients who have undergone previous radiation treatment or who have chronic lymphedema also face an elevated risk of this condition. Various genetic changes are suspected to contribute to the development of angiosarcoma, and these changes have been identified as potential targets for treatment. For localized disease, wide surgical resection is often the prudent course of action. A multidisciplinary approach, which may include surgery, radiotherapy, systemic chemotherapy, or immunotherapy, is typically the most effective way to achieve favorable outcomes. In this review, we discuss the general understanding of angiosarcoma and its management, with a particular focus on the current evolving treatments for the disease.
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Affiliation(s)
- Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong, Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
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29
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Blatt J, Brondon JE, Nieman EL, Phillips K, Pandya A. Repurposing of antiangiogenic agents for treatment of vascular anomalies. Pharmacol Ther 2023; 250:108520. [PMID: 37625520 DOI: 10.1016/j.pharmthera.2023.108520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
Vascular anomalies (VA) are developmental anomalies of veins, arteries, lymphatics or capillaries thought to be caused by mutations in genes that drive angiogenesis. Treatments targeting these genes are limited. We review the literature for conventional medications and products from traditional medicine cultures that have been found to have antiangiogenic activity. Fewer than 50 drugs with credible human activity in VA were identified and include β blockers, monoclonal antibodies, microtubule inhibitors, multi-kinase inhibitors, PIK3CA- and RAS-MAPK pathway inhibitors, and thalidomides. Other drug categories of potential interest are ACE-inhibitors, antifungals, antimalarials, MMP9-inhibitors, and over-the-counter compounds used in Eastern traditional medicine. Low toxicity for some offers the possibility of combined use with known effective agents. In addition to already familiar drugs, others with antiangiogenic capabilities already in use in children or adults may deserve further attention for repurposing for VA.
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Affiliation(s)
- Julie Blatt
- Division of Hematology Oncology, Department of Pediatrics, and the Lineberger Clinical Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Jennifer E Brondon
- Division of Hematology Oncology, Department of Pediatrics, and the Lineberger Clinical Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth L Nieman
- Department of Dermatology, Univerity of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kynlon Phillips
- The Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Arti Pandya
- Division of Genetics and Metabolism, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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30
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Kapturska KM, Pawlak A. New molecular targets in canine hemangiosarcoma-Comparative review and future of the precision medicine. Vet Comp Oncol 2023; 21:357-377. [PMID: 37308243 DOI: 10.1111/vco.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
Human angiosarcoma and canine hemangiosarcoma reveal similarities not only in their aggressive clinical behaviour, but especially in molecular landscape and genetic alterations involved in tumorigenesis and metastasis formation. Currently, no satisfying treatment that allows for achieving long overall survival or even prolonged time to progression does not exist. Due to the progress that has been made in targeted therapies and precision medicine the basis for a new treatment design is to uncover mutations and their functions as possible targets to provide tailored drugs for individual cases. Whole exome or genome sequencing studies and immunohistochemistry brought in the last few years important discoveries and identified the most common mutations with probably crucial role in this tumour development. Also, despite a lack of mutation in some of the culprit genes, the cancerogenesis cause may be buried in main cellular pathways connected with proteins encoded by those genes and involving, for example, pathological angiogenesis. The aim of this review is to highlight the most promising molecular targets for precision oncology treatment from the veterinary perspective aided by the principles of comparative science. Some of the drugs are only undergoing laboratory in vitro studies and others entered the clinic in the management of other cancer types in humans, but those used in dogs with promising responses have been mentioned as priorities.
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Affiliation(s)
- Karolina Małgorzata Kapturska
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
- Veterinary Clinic NEOVET s.c. Hildebrand, Jelonek, Michalek-Salt, Wroclaw, Poland
| | - Aleksandra Pawlak
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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Kobayashi K, Hanai N, Yoshimoto S, Saito Y, Homma A. Current topics and management of head and neck sarcomas. Jpn J Clin Oncol 2023; 53:743-756. [PMID: 37309253 PMCID: PMC10533342 DOI: 10.1093/jjco/hyad048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023] Open
Abstract
Given the low incidence, variety of histological types, and heterogeneous biological features of head and neck sarcomas, there is limited high-quality evidence available to head and neck oncologists. For resectable sarcomas, surgical resection followed by radiotherapy is the principle of local treatment, and perioperative chemotherapy is considered for chemotherapy-sensitive sarcomas. They often originate in anatomical border areas such as the skull base and mediastinum, and they require a multidisciplinary treatment approach considering functional and cosmetic impairment. Moreover, head and neck sarcomas may exhibit different behaviour and characteristics than sarcomas of other areas. In recent years, the molecular biological features of sarcomas have been used for the pathological diagnosis and development of novel agents. This review describes the historical background and recent topics that head and neck oncologists should know about this rare tumour from the following five perspectives: (i) epidemiology and general characteristics of head and neck sarcomas; (ii) changes in histopathological diagnosis in the genomic era; (iii) current standard treatment by histological type and clinical questions specific to head and neck; (iv) new drugs for advanced and metastatic soft tissue sarcomas; and (v) proton and carbon ion radiotherapy for head and neck sarcomas.
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Affiliation(s)
- Kenya Kobayashi
- Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Yuki Saito
- Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo
| | - Akihiro Homma
- Department of Otolaryngology–Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Esperança-Martins M, Melo-Alvim C, Dâmaso S, Lopes-Brás R, Peniche T, Nogueira-Costa G, Abreu C, Luna Pais H, de Sousa RT, Torres S, Gallego-Paez LM, Martins M, Ribeiro L, Costa L. Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Turning the Magnifying Glass on Rare and Aggressive Entities. Cancers (Basel) 2023; 15:3933. [PMID: 37568749 PMCID: PMC10416994 DOI: 10.3390/cancers15153933] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Breast sarcomas (BSs), phyllodes tumors (PTs), and desmoid tumors (DTs) are rare entities that arise from connective tissue. BSs can be classified as either primary or secondary, whether they develop de novo or after radiation exposure or lymphedema. PIK3CA seems to play an important common role in different BS. Malignant PTs show similar behavior to BSs, while DTs are locally aggressive but rarely metastasize. BSs usually present as unilateral, painless, rapidly growing masses with rare nodal involvement. The diagnosis should be based on magnetic resonance imaging and a core needle biopsy. Staging should comprise a chest computed tomography (CT) scan (except for benign PT and DT), while abdominal and pelvic CT scans and bone scans should be added in certain subtypes. The mainstay of treatment for localized BS is surgery, with margin goals that vary according to subtype. Radiotherapy and chemotherapy can be used as neoadjuvant or adjuvant approaches, but their use in these settings is not standard. Advanced BS should be treated with systemic therapy, consistent with recommendations for advanced soft tissue sarcomas of other topographies. Given the rarity and heterogeneity of these entities, multidisciplinary and multi-institutional collaboration and treatment at reference centers are critical.
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Affiliation(s)
- Miguel Esperança-Martins
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Cecília Melo-Alvim
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sara Dâmaso
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Raquel Lopes-Brás
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Tânia Peniche
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Gonçalo Nogueira-Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Catarina Abreu
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Helena Luna Pais
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Rita Teixeira de Sousa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sofia Torres
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Lina Marcela Gallego-Paez
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Marta Martins
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Leonor Ribeiro
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Luís Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
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Degnim AC, Siontis BL, Ahmed SK, Hoskin TL, Hieken TJ, Jakub JW, Baum CL, Day C, Schrup SE, Smith L, Carter JM, Sae Kho TM, Glazebrook KN, Vijayasekaran A, Okuno SH, Petersen IA. Trimodality Therapy Improves Disease Control in Radiation-Associated Angiosarcoma of the Breast. Clin Cancer Res 2023; 29:2885-2893. [PMID: 37223927 DOI: 10.1158/1078-0432.ccr-23-0443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To evaluate the impact of trimodality treatment versus monotherapy or dual therapy for radiation-associated angiosarcoma of the breast (RAASB) after prior breast cancer treatment. EXPERIMENTAL DESIGN With Institutional Review Board approval, we identified patients diagnosed with RAASB and abstracted data on disease presentation, treatment, and oncologic outcomes. Trimodality therapy included (i) taxane induction, (ii) concurrent taxane/radiation, and then (iii) surgical resection with wide margins. RESULTS A total of 38 patients (median age 69 years) met inclusion criteria. Sixteen received trimodality therapy and 22 monotherapy/dual therapy. Skin involvement and disease extent were similar in both groups. All trimodality patients required reconstructive procedures for wound closure/coverage, compared with 48% of monotherapy/dual therapy patients (P < 0.001). Twelve of 16 (75%) patients receiving trimodality therapy had a pathologic complete response (pCR). With median follow-up of 5.6 years, none had local recurrence, 1 patient (6%) had distant recurrence, and no patients died. Among 22 patients in the monotherapy/dual therapy group, 10 (45%) had local recurrence, 8 (36%) had distant recurrence, and 7 (32%) died of disease. Trimodality therapy demonstrated significantly better 5-year recurrence-free survival [RFS; 93.8% vs. 42.9%; P = 0.004; HR, 7.6 (95% confidence interval, CI: 1.3-44.2)]. Combining all patients with RAASB regardless of treatment, local recurrence was associated with subsequent distant recurrence (HR, 9.0; P = 0.002); distant recurrence developed in 3 of 28 (11%) patients without local recurrence compared with 6 of 10 (60%) with local recurrence. The trimodality group had more surgical complications that required reoperation or prolonged healing. CONCLUSIONS Trimodality therapy for RAASB was more toxic but is promising, with a high rate of pCR, durable local control, and improved RFS.
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Affiliation(s)
- Amy C Degnim
- Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Safia K Ahmed
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Tanya L Hoskin
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Division of Surgical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Courtney Day
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Schrup
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lauren Smith
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jodi M Carter
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Dermawan JK, Chi P, Tap WD, Rosenbaum E, D'Angelo S, Alektiar KM, Antonescu CR. Distinct genomic landscapes in radiation-associated angiosarcoma compared with other radiation-associated sarcoma histologies. J Pathol 2023; 260:465-477. [PMID: 37350195 PMCID: PMC10756077 DOI: 10.1002/path.6137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
MYC amplifications have been frequently detected in radiation (RT)-associated angiosarcomas (ASs) by low-resolution molecular methods. However, large-scale next-generation sequencing (NGS) studies to investigate the genomic landscape of RT-AS are scarce, particularly compared with other RT-associated sarcomas. We performed a detailed comparative genomic investigation of RT-AS versus other RT-associated histotypes, as well as sporadic sarcomas with similar histologies. Our institutional targeted DNA-NGS assay database was searched for RT-associated sarcomas. Clinical outcome data, pathologic diagnosis, and the types and frequencies of genomic alterations, including single nucleotide variants (SNVs) and copy number alterations (CNAs), were analyzed. The cohort consisted of 82 patients, 68 (83%) females and 14 (17%) males, aged 37-88 (mean 64) years. Forty-four RT-ASs (38 from breast) and 38 RT sarcomas of other histologies, including 12 malignant peripheral nerve sheath tumors (RT-MPNSTs), 14 undifferentiated pleomorphic sarcomas (RT-UPSs), and 12 osteosarcomas (RT-OSs), were included. Median time intervals from radiation to initial diagnosis in RT-AS (8.0 years) were significantly lower than those in RT-MPNST and RT-UPS (12.5 and 18.5 years), respectively. Each RT-sarcoma histotype harbored distinct mutations and CNAs. RT-associated AS had more frequent MYC, FLT4, CRKL, HRAS, and KMT2D alterations than sporadic AS (enriched in TP53, KDR, ATM, ATRX), whereas the mutational landscapes of MPNST, UPS, and OS were similar in both RT and non-RT settings. CDKN2A/B deletions and TP53 alterations were infrequent in RT-AS compared with other RT sarcomas. Among RT sarcomas, RT-AS harbored the lowest fraction of genome altered (FGA), while RT-MPNST showed the highest FGA. RT-AS had the lowest insertion:SNV and deletion:SNV ratios, while RT-UPS had the highest. The predominant mutational signatures were associated with errors in DNA repair and replication. In conclusion, RT-AS has a distinct genomic landscape compared with other RT sarcomas and sporadic AS. Potential molecular targets for precision medicine may be histotype-dependent. © 2023 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Josephine K Dermawan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sandra D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina R Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Rodriguez-Cid JR, Juarez-Vignon Whaley JJ, Sánchez-Domínguez G, Guzmán-Casta J, Carrasco-CaraChards S, Guzmán-Huesca J, Riera-Sala R, Sánchez-Ríos CP, Cruz-Zermeño M, Seidman-Sorsby A, de Jesús Rodríguez-Zea I, Alatorre-Alexander JA, Martínez-Barrera LM, Santillán-Doherty PJ, Godina-Flores A, Imaz-Olguin V, Sosa-Sánchez R, Green-Renner D. Epirubicin, cisplatin plus ifosfamide versus standard chemotherapeutic regimens for advanced/unresectable primary thoracic sarcomas. J Cancer Res Clin Oncol 2023; 149:5479-5491. [PMID: 36463530 DOI: 10.1007/s00432-022-04454-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/26/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE Thoracic sarcomas are rare malignancies, with limited data for unresectable/advanced scenarios. Our goal is to provide insights of a three-drug chemotherapy regimen improving patient survival compared to standard regimens. METHODS Retrospective cohort analysis of patients diagnosed with unresectable/advanced primary thoracic sarcoma divided between primary pulmonary sarcomas (PPS) and chest wall sarcomas (CWS) comparing chemotherapeutical regimens efficacy. Not true soft tissue sarcomas (STS) for PPS were excluded from the analysis. Univariate and multivariate analysis performed via Cox-regression model. Progression-free survival (PFS) and overall survival (OS) analysis via Kaplan-Meier with hazard ratio (HR) obtained via Mantel-Haenszel or log rank. RESULTS 157 total cases were included, from which 50 cases were PPS and 107 cases CWS. For PPS, 4 cases were excluded from the analysis as they were not true STS. The most common histology was undifferentiated sarcomas, 63% of cases were treated with E/C/I and 37% with another regimen. The E/C/I regimen demonstrated a benefit for both OS (p = 0.020) and PFS (p = 0.010) when compared to any other regimen as well as when compared to non-platinum regimens (p = 0.016 and p = 0.001). Regarding CWS, the most common histology was synovial and undifferentiated sarcomas, 55.1% were treated with E/C/I and 44.9% treated with another regimen. The E/C/I regimen did not demonstrate a benefit for OS or PFS compared to any other regimen, neither when compared to other non-platinum regimens. However, a benefit was observed in favor of E/C/I when compared to other platinum regimens in both OS (p = 0.049) and PFS (0.015). Both analyses for PPS and CWS demonstrated a benefit in favor of cisplatin therapies compared to carboplatin in both OS and PFS. CONCLUSION This study demonstrates that platinum therapy alone does not work, and that cisplatin must be the agent of choice and it's used in combination could increase treatment response. The E/C/I regimen demonstrated a in PPS but not for CWS, this is due do their rarity of PPS and that no standard treatment is established yet. The regimen proposed here could represent a possible new standard of treatment for PPS as long as it is validated in a prospective study.
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Affiliation(s)
- Jeronimo Rafael Rodriguez-Cid
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico.
| | - Juan Jose Juarez-Vignon Whaley
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
- Health Science Research Center, Faculty of Health Science, Universidad Anáhuac México, Av. Universidad Anáhuac 46, Lomas Anahuac, 52786, Naucalpan de Juárez, State of Mexico, Mexico
| | - Gisela Sánchez-Domínguez
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Jordi Guzmán-Casta
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Sonia Carrasco-CaraChards
- Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
| | - Jorge Guzmán-Huesca
- Department of Internal Medicine, Bonita Community Health Center, 3501 Health Center Blvd, Bonita Springs, Florida, 34135, USA
| | - Rodrigo Riera-Sala
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Carla Paola Sánchez-Ríos
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Mayte Cruz-Zermeño
- Faculty of Medicine, Universidad Panamericana, Augusto Rodin No. 498, Insurgentes Mixcoac, Benito Juárez, 03920, Mexico City, Mexico
| | - Alec Seidman-Sorsby
- Faculty of Medicine, Universidad Panamericana, Augusto Rodin No. 498, Insurgentes Mixcoac, Benito Juárez, 03920, Mexico City, Mexico
| | - Ivan de Jesús Rodríguez-Zea
- Faculty of Medicine, Universidad Nacional Autónoma de México, Escolar 411A, Copilco Universidad, 04360, Mexico City, Mexico
| | - Jorge Arturo Alatorre-Alexander
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Luis Manuel Martínez-Barrera
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Patricio Javier Santillán-Doherty
- Department of Thoracic Oncology, Instituto Nacional de Enfermedades Respiratorias, Dr. Ismael Cosío Villegas, Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Aminadab Godina-Flores
- Faculty of Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, C. Puente 222, Coapa, Arboledas del Sur, Tlalpan, 14380, Mexico City, Mexico
| | - Victoria Imaz-Olguin
- Department of Oncology, Hospital Angeles del Pedregal, Camino Sta. Teresa 1055-S, Heroes de Padierna, Héroes de Padierna, La Magdalena Contreras, 10700, Mexico City, Mexico
| | - Ricardo Sosa-Sánchez
- Medica Sur Cancer Center Director, Medica Sur, Puente de Piedra 150, Toriello Guerra, Tlalpan, 14050, Mexico City, Mexico
| | - Dan Green-Renner
- Department of Oncology, Hospital Angeles del Pedregal, Camino Sta. Teresa 1055-S, Heroes de Padierna, Héroes de Padierna, La Magdalena Contreras, 10700, Mexico City, Mexico
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Yoder AK, Farooqi AS, Wernz C, Subramaniam A, Ravi V, Goepfert R, Sturgis EM, Mitra D, Bishop AJ, Guadagnolo BA. Outcomes after definitive treatment for cutaneous angiosarcomas of the face and scalp: Reevaluating the role of surgery and radiation therapy. Head Neck 2023; 45:1943-1951. [PMID: 37272774 PMCID: PMC11350586 DOI: 10.1002/hed.27418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION We investigated outcomes and prognostic factors for patients treated for cutaneous angiosarcoma (CA). METHODS We conducted a retrospective review of patients treated for CA of the face and scalp from 1962 to 2019. All received definitive treatment with surgery, radiation (RT), or a combination (S-XRT). The Kaplan-Meier method was used to estimate outcomes. Multivariable analyses were conducted using the Cox proportional hazards model. RESULTS For the 143 patients evaluated median follow-up was 33 months. Five-year LC was 51% and worse in patients with tumors >5 cm, multifocal tumors, those treated pre-2000, and with single modality therapy (SMT). These remained associated with worse LC on multivariable analysis. The 5-year disease-specific survival (DSS) for the cohort was 56%. Tumor size >5 cm, non-scalp primary site, treatment pre-2000, and SMT were associated with worse DSS. CONCLUSION Large or multifocal tumors are negative prognostic factors in patients with head and neck CA. S-XRT improved outcomes.
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Affiliation(s)
- Alison K Yoder
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahsan S Farooqi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Cort Wernz
- Baylor College of Medicine, Houston, Texas, USA
| | - Aparna Subramaniam
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Goepfert
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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Dhabhar JB, Mehta V. Recurrent metastatic angiosarcoma presenting as Kasabach-Merritt syndrome. BMJ Case Rep 2023; 16:e255134. [PMID: 37500188 PMCID: PMC10387657 DOI: 10.1136/bcr-2023-255134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Angiosarcoma is an incredibly rare type of malignancy, accounting for only 1%-2% of all soft-tissue sarcomas globally. It is clinically, pathologically and radiologically difficult to diagnose angiosarcoma owing to its varied presentation with little or no well-defined imaging findings.Kasabach-Merritt syndrome is also a lesser-heard entity which carries extremely poor prognosis. It is primarily seen in infants with vascular malformations and in kaposiform haemangioendothelioma. It is a condition of consumptive coagulopathy and only few of the cases have been reported so far in the adults with a background of angiosarcoma.This report presents the case of a male in his 70s who was diagnosed with metastatic angiosarcoma and experienced a complicated disease course due to Kasabach-Merritt syndrome.
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Affiliation(s)
- Jeyhan Boman Dhabhar
- Medical Oncology, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
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Dufresne A, Meeus P, Sunyach MP. Treatment of radiation-associated angiosarcoma. Curr Opin Oncol 2023; 35:296-300. [PMID: 37222197 DOI: 10.1097/cco.0000000000000958] [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: 05/25/2023]
Abstract
PURPOSE OF REVIEW Radiation-associated angiosarcoma is a cutaneous aggressive tumor that is very rare and it represents a specific entity poorly studied in literature. It requires new therapeutic opportunity. RECENT FINDINGS The complete surgical resection with negative margins is the mainstay treatment of localized treatment, even though it is difficult to reach in case of diffuse cutaneous infiltration. Adjuvant re-irradiation may improve local control with no benefit demonstrated on survival. Many systemic treatments can be efficient not only in metastatic setting but also in neoadjuvant setting in case of diffuse presentation. These treatments have never been compared to each other; the most efficient regimen remains to be determined, and a high heterogeneity of treatment is observed, even between sarcoma reference centers. SUMMARY Immune therapy represents the most promising treatment under development. At the time of building clinical trial to assess the efficacy of immune therapy, the lack of randomized studies prevents the identification of a strong and consensual reference arm treatment. Given the rarity of the disease, only international collaborative clinical trials may have a chance to include enough patients to draw any conclusion and so will have to counteract the heterogeneity of management.
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Balko J, Ozaniak A, Krskova L, Strizova Z, Lischke R, Zamecnik J. Patient with composite haemangioendothelioma containing angiosarcoma-like areas in the setting of congenital lymphoedema mimicking Stewart-Treves syndrome: a case report. Diagn Pathol 2023; 18:76. [PMID: 37349756 DOI: 10.1186/s13000-023-01365-1] [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: 01/09/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Composite haemangioendothelioma is a rare vascular neoplasm with indolent to intermediate malignant potential. Diagnosis of this disease relays on histopathological identification of at least two different morphologically distinctive vascular components in proper clinical settings. Exceedingly rare cases of this neoplasm can exhibit areas resembling high-grade angiosarcoma, which does not change the biological behaviour. Such lesions tend to occur in the setting of chronic lymphoedema and thus, can mimic Stewart-Treves syndrome, which has a much worse clinical outcome and prognosis. CASE PRESENTATION We present a case of 49 years old male suffering from chronic lymphoedema of the left lower extremity who had developed a composite haemangioendothelioma with high grade angiosarcoma-like areas mimicking the Stewart-Treves syndrome. Given the multifocality of the disease, the only potentially curable surgical treatment would be hemipelvectomy, which was refused by the patient. The patient has been followed-up, with no signs of local progression of the remaining disease, nor a distant spread outside the involved extremity for two years. CONCLUSIONS Composite haemangioendothelioma represents a rare malignant vascular tumour, with significantly more favourable biological behaviour than angiosarcoma, even in cases where angiosarcoma-like areas are present. For that reason, composite haemangioendothelioma can be easily misdiagnosed as true angiosarcoma. The rarity of this disease unfortunately hampers the development of clinical practice guidelines and the implementation of treatment recommendations. Most of the patients with localized tumour are treated by wide surgical resection, without neo- or adjuvant radiotherapy or chemotherapy. However, in the case of this diagnosis, the watch-and-wait approach is better than mutilating procedure, highlighting the necessity of establishing of the correct diagnosis.
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Affiliation(s)
- Jan Balko
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Andrej Ozaniak
- 3rd Department of Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lenka Krskova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zuzana Strizova
- Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Robert Lischke
- 3rd Department of Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Stergioula A, Pantelakos P, Varthalitis I, Agrogiannis G, Pantelis E. Treatment of an unresectable cardiac angiosarcoma using paclitaxel and image guided radiotherapy: Case report and literature review. Clin Transl Radiat Oncol 2023; 40:100619. [PMID: 37025606 PMCID: PMC10070361 DOI: 10.1016/j.ctro.2023.100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Primary cardiac angiosarcomas (PCAs) are rare tumors that are typically found in the right atrium between the third and the fifth decade of life. While surgical removal of the tumor combined with adjuvant chemotherapy and/or radiotherapy is the treatment of choice, most of the patients present with unresectable tumors and metastatic disease carrying a dismal prognosis with a median survival of less than 1 year. Doxorubicin and ifosfamide based chemotherapy combined with radiotherapy is currently employed in these patients, but no standardized treatment algorithms exist. In this report, we present the management of a patient with an unresectable PCA treated using weekly paclitaxel (120 mg) combined with radiotherapy (60 Gy in 30 fractions) delivered by a helical TomoTherapy system. Follow-up imaging studies showed a remarkable tumor regression which allowed for surgical excision of the tumor 10 months post treatment. Histopathological examination of the resected mass showed no viable tumor cell. On the latest follow-up study, 12 months post treatment, no sign of disease progression (local or distant) was found, and the patient is in good clinical condition.
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Heater NK, Okuno S, Robinson S, Attia S, Seetharam M, Siontis BL, Yoon J, Chawla S, Milhem MM, Monga V, Skubitz K, Charlson J, Hirbe AC, Weiss MC, Van Tine B, Agulnik M. The Midwest Sarcoma Trials Partnership: Bridging Academic and Community Networks in a Collaborative Approach to Sarcoma. J Clin Med 2023; 12:2561. [PMID: 37048645 PMCID: PMC10095464 DOI: 10.3390/jcm12072561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
The treatment of sarcoma necessitates a collaborative approach, given its rarity and complex management. At a single institution, multidisciplinary teams of specialists determine and execute treatment plans involving surgical, radiation, and medical management. Treatment guidelines for systemic therapies in advanced or nonresectable soft tissue sarcoma have advanced in recent years as new immunotherapies and targeted therapies become available. Collaboration between institutions is necessary to facilitate accrual to clinical trials. Here, we describe the success of the Midwest Sarcoma Trials Partnership (MWSTP) in creating a network encompassing large academic centers and local community sites. We propose a new model utilizing online platforms to expand the reach of clinical expertise for the treatment of advanced soft tissue sarcoma.
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Affiliation(s)
- Natalie K. Heater
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Scott Okuno
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Steven Robinson
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Steven Attia
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Mahesh Seetharam
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Janet Yoon
- City of Hope Medical Center, Duarte, CA 91010, USA
| | - Sant Chawla
- Sarcoma Oncology Center, Santa Monica, CA 90403, USA
| | - Mohammed M. Milhem
- Department of Internal Medicine, Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA 52242, USA
| | - Varun Monga
- Department of Internal Medicine, Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA 52242, USA
| | - Keith Skubitz
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - John Charlson
- Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Angela C. Hirbe
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Mia C. Weiss
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Brian Van Tine
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Mark Agulnik
- City of Hope Medical Center, Duarte, CA 91010, USA
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42
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El-Ghazzi N, Bay JO. [Rare tumors: Angiosarcoma]. Bull Cancer 2023; 110:581-588. [PMID: 36973135 DOI: 10.1016/j.bulcan.2023.03.002] [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: 11/14/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
Angiosarcomas are a rare subtype representing 1-2% of soft tissue sarcomas. Risk factors are rarely elucidated but radiotherapy and lymphedema are the most common ones, usually following local treatment for local breast cancer. Despite the improvement of our knowledge, the prognosis remains poor with 35-40% of 5 year-overall survival. Local treatment when feasible should include a R0 surgery completed with adjuvant radiation. When metastatic, front lines chemotherapies include doxorubicine or weekly paclitaxel. If possible, in oligometastatic patients, metastasectomy should always be considered allowing the best responses. The knowledge of angiosarcoma's biology is rapidly increasing and new biomarkers are emerging. The use of immunotherapy in particular subtypes including head and neck angiosarcomas shows promising results. The model of the angiosarcoma project, a patient-participating study, seems to be an excellent way to study rare tumors. We should focus our efforts on understanding the underlying molecular biology to propose the best precision medicine for those patients.
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Affiliation(s)
- Nathan El-Ghazzi
- CHU Gabriel-Montpied, service d'oncologie médicale, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Jacques-Olivier Bay
- CHU Gabriel-Montpied, service d'oncologie médicale, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
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Fujimura T, Maekawa T, Kato H, Ito T, Matsushita S, Yoshino K, Fujisawa Y, Ishizuki S, Segawa K, Yamamoto J, Hashimoto A, Kambayashi Y, Asano Y. Treatment for taxane-resistant cutaneous angiosarcoma: A multicenter study of 50 Japanese cases. J Dermatol 2023. [PMID: 36938650 DOI: 10.1111/1346-8138.16786] [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: 12/20/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
Cutaneous angiosarcoma (CAS) is a rare and highly aggressive type of vascular tumor. Although chemoradiotherapy with taxanes is recognized as a first-line therapy for CAS, second-line therapy for CAS remains controversial. From the above findings, the efficacy and safety profiles of taxane-switch (change paclitaxel to docetaxel or vise), eribulin methylate, and pazopanib regimens in second-line chemotherapy were evaluated retrospectively in 50 Japanese taxane-resistant CAS patients. Although there was no significant difference in progression-free survival (P = 0.3528) among the regimens, the incidence of all adverse events (AEs) (P = 0.0386), as well as severe G3 or more AEs (P = 0.0477) was significantly higher in the eribulin methylate group and pazopanib group than in the taxane-switch group. The present data suggest that switching to another taxane should be considered for the treatment of taxane-resistant CAS in second-line therapy based on the safety profiles.
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Affiliation(s)
- Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Koji Yoshino
- Department of Dermato-Oncology/Dermatology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Dermato-Oncology/Dermatology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan.,Department of Dermatology, University of Ehime, Matsuyama, Japan
| | | | - Kojiro Segawa
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Yamamoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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44
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Guan L, Palmeri M, Groisberg R. Cutaneous angiosarcoma: A review of current evidence for treatment with checkpoint inhibitors. Front Med (Lausanne) 2023; 10:1090168. [PMID: 36993810 PMCID: PMC10040781 DOI: 10.3389/fmed.2023.1090168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
Cutaneous angiosarcoma (cAS) is a rare and aggressive subtype of soft tissue sarcoma with poor prognosis and suboptimal treatment options. Clinical presentation is variable, but cAS often arises from the head and neck. The most widely accepted current approach, surgical excision with adjuvant radiotherapy, is associated with high recurrence rates and can leave patients with profound disfigurement. Chemotherapy and targeted therapy alternatives have had limited success. Thus, there is a significant unmet need to address the absence of durable treatments for advanced and metastatic cAS. Like melanoma and cutaneous squamous cell carcinoma, tumor types with known response to immunotherapy, cAS harbors immune biomarkers, such as tumor mutational burden high (TMB-H), PD-L1 positivity, ultraviolet signature expression, and tertiary lymphoid structures. While data on the use and efficacy of immunotherapy in cAS is limited, the biomarkers suggest a promising advancement in future treatment options. This review aims to summarize and discuss current data from case reports, case series, retrospective studies and clinical trials regarding immunotherapy treatment and outcomes for cAS.
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45
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Kishida T. Editorial Comment on A case of mediastinal teratoma with malignant transformation into angiosarcoma and relapse with multiple bone metastases that was cured by multidisciplinary treatment. IJU Case Rep 2023; 6:96. [PMID: 36874998 PMCID: PMC9978068 DOI: 10.1002/iju5.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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46
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Yamauchi Y, Saeki I, Yamasaki T, Egusa M, Nishiyama N, Fujioka T, Kawamoto D, Nishimura T, Tanabe N, Oono T, Matsumoto T, Ishikawa T, Marumoto Y, Matsukuma S, Shindo Y, Tokumitsu Y, Yoshimine S, Murakami J, Tanaka T, Kimura S, Hoshii Y, Hamano K, Nagano H, Takami T. Double cancer of primary hepatic angiosarcoma and hepatocellular carcinoma treated with atezolizumab plus bevacizumab. Hepatol Res 2023. [PMID: 36826420 DOI: 10.1111/hepr.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023]
Abstract
AIM Primary hepatic angiosarcoma (PHA) is extremely rare, and its imaging findings are similar to those of other liver tumors including hepatocellular carcinoma (HCC). Here, we report a case of hepatitis C virus (HCV)-related HCC followed by PHA that showed remarkable clinical response to atezolizumab plus bevacizumab (Atezo/Bev) therapy. CASE PRESENTATION A 78-year-old man with recurrent HCC had a liver tumor with lymphadenopathy. Although considered as HCC recurrence, microscopic examination of the resected liver and lymph node showed PHA. Three months later, a solitary lung nodule was newly detected and subsequently resected. The pathological diagnosis was poorly differentiated HCC. Therefore, the patient was finally diagnosed with double cancer of PHA and HCC. Thereafter, he developed a new liver tumor with lymphadenopathy and received Atezo/Bev therapy. Liver tumor biopsy was carried out before the treatment. The pathological diagnosis was angiosarcoma. The patient showed a partial response after two courses of Atezo/Bev therapy. CONCLUSION To our best knowledge, this report is the first case to present HCV-related HCC followed by PHA and to show that Atezo/Bev therapy is beneficial for PHA.
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Affiliation(s)
- Yurika Yamauchi
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Issei Saeki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takahiro Yamasaki
- Department of Oncology and Laboratory, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Maho Egusa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Natsuko Nishiyama
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tsuyoshi Fujioka
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Daiki Kawamoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tatsuro Nishimura
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Norikazu Tanabe
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Department of Oncology and Laboratory, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takashi Oono
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toshihiko Matsumoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tsuyoshi Ishikawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshio Marumoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Center for Clinical Research, Yamaguchi University Hospital, Ube, Japan
| | - Satoshi Matsukuma
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Sota Yoshimine
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toshiki Tanaka
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Sotai Kimura
- Department of Molecular Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshinobu Hoshii
- Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Taro Takami
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Ohuchi K, Amagai R, Ikawa T, Muto Y, Roh Y, Endo J, Maekawa T, Kambayashi Y, Asano Y, Fujimura T. Plasminogen activating inhibitor-1 promotes angiogenesis in cutaneous angiosarcomas. Exp Dermatol 2023; 32:50-59. [PMID: 36168721 DOI: 10.1111/exd.14681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 01/12/2023]
Abstract
Plasminogen activating inhibitor-1 (PAI-1) is associated with poor clinical outcomes, and elevated levels of PAI-1 in both tissue and serum are correlated with poor response to therapy in various cancers, including skin cancer. Cutaneous angiosarcoma (CAS) is a vascular tumor histologically characterized by detachment of endothelial cell-derived tumor cells. Since CAS expresses multiple angiogenic growth factors and has increased expressions of angiogenic receptor tyrosine kinase transcripts including VEGFR1/2/3, angiogenesis-promoting factors are potential drug targets in CAS. In this study, the expression of PAI-1 was examined in 31 cases of CAS, and the immunomodulatory effects of PAI-1 on a human CAS cell line, ISO-HAS-B, were evaluated. We found that, of the angiogenesis-promoting factors, PAI-1 was expressed in almost all cases of CAS, and PAI-1 increased the mRNA expressions of IL-23p19, VEGF-C, CXCL5 and CCL20 on ISO-HAS-B. Moreover, PAI-1 stimulated ISO-HAS-B culture supernatant promoted favourable tube networks, suggesting that these tumor-derived factors promote the pro-angiogenic effect on tumor development. In addition, IL-23p19 was expressed in 61.3% of cases, whereas VEGF-C was expressed in 41% of cases. The results of the present study suggest that PAI-1 promotes angiogenesis that results in tumor progression in CAS.
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Affiliation(s)
- Kentaro Ohuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Amagai
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Ikawa
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Muto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuna Roh
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junko Endo
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kamitani R, Matsumoto K, Takeda T, Mizuno R, Oya M. Evaluation of prognostic factors and treatment options for renal angiosarcoma: A retrospective analysis of 113 reported cases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:263-270. [PMID: 36116986 DOI: 10.1016/j.ejso.2022.09.001] [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: 04/20/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Primary renal angiosarcoma (PRA) is an extremely rare and aggressive neoplasm. Indeed, due to its rarity, established clinical guidelines for PRA have not yet been established. In this study, we attempted to investigate its prognostic factors and treatment options. METHODS We systematically searched for articles describing PRA that had been published up until December 2021. The final cohort included 113 patients in 103 articles. The starting point of this study was the time of diagnosis and the end point was the time of recurrence and disease-specific mortality. RESULTS Metastasis at diagnosis was associated with poorer disease-specific survival (DSS) (p = 0.001). Tumors of more than 5 cm had poorer DSS than tumors of 5 cm or less (p < 0.001). Multivariate analysis demonstrated that primary metastatic status, and tumor size were independent prognostic factors. In cases of localized PRA, tumor sizes exceeding 5 cm had also prognostic significance for recurrence-free survival (RFS) and DSS. Surgical margins, postoperative radiation, and postoperative systemic therapy were not associated with prognoses. However, in a subgroup analysis of tumors exceeding 5 cm, postoperative radiation therapy improved RFS and DSS (p = 0.022 and p = 0.031, respectively). In cases of metastatic PRA, systemic therapy improved DSS (p < 0.001). CONCLUSION We identified several prognostic factors for PRA. Among them, primary metastatic status and tumor size exceeding 5 cm were selected as independent prognostic factors. Postoperative radiation therapy for large, localized PRA and systemic therapy for recurrent and metastatic PRA might be a treatment option.
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Affiliation(s)
- Rei Kamitani
- Keio University School of Medicine, Department of Urology, Japan
| | | | - Toshikazu Takeda
- Keio University School of Medicine, Department of Urology, Japan
| | - Ryuichi Mizuno
- Keio University School of Medicine, Department of Urology, Japan
| | - Mototsugu Oya
- Keio University School of Medicine, Department of Urology, Japan
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49
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Fujimura T, Furudate S, Maekawa T, Kato H, Ito T, Matsushita S, Yoshino K, Hashimoto A, Muto Y, Ohuchi K, Amagai R, Kambayashi Y, Fujisawa Y. Cutaneous angiosarcoma treated with taxane-based chemoradiotherapy: A multicenter study of 90 Japanese cases. SKIN HEALTH AND DISEASE 2022; 3:e180. [PMID: 36751323 PMCID: PMC9892413 DOI: 10.1002/ski2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022]
Abstract
Cutaneous angiosarcoma (CAS) is rare and most previous studies of CAS have been small case series, and randomized, phase II studies of CAS are limited. Since treatment options for CAS are controversial, and because only paclitaxel should be recommended based on high-level evidence, it is important to evaluate the efficacy of another taxane-derived agents, docetaxel, in real-world practice. The efficacy and safety profiles of chemoradiotherapy using taxane-based agents, docetaxel and paclitaxel, were retrospectively examined in the maintenance setting in 90 Japanese CAS patients, including 35 docetaxel-treated cases and 55 paclitaxel-treated cases. Overall survival and dose duration time of the patient group treated with docetaxel was equivalent to that with paclitaxel, even in the cohorts with metastasis. Adverse events due to docetaxel and paclitaxel were observed in 77.1% and 69.1% of cases, respectively. The incidence ratio of total severe adverse events tended to be higher in the docetaxel-treated group (40.0%) than in the paclitaxel-treated group (23.6%). Peripheral neuropathy occurred only in the paclitaxel-treated group, whereas high-grade interstitial pneumonia developed only in the docetaxel-treated group. In addition, we also evaluate 19 patients selected other taxanes, 17 patients selected eribulin methylate, 11 patients pazopanib, and 2 patients selected nivolumab as second-line chemotherapy. The efficacy of a monthly docetaxel regimen is equivalent to a three-weekly paclitaxel regimen evaluated by Overall survival and DDT, even in the cohorts with metastasis, and it is a tolerable protocol for CAS as a maintenance therapy in the Japanese population.
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Affiliation(s)
- Taku Fujimura
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Sadanori Furudate
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Takeo Maekawa
- Department of DermatologyJichi Medical SchoolShimonoJapan
| | - Hiroshi Kato
- Department of Geriatric and Environmental DermatologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Takamichi Ito
- Department of DermatologyGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shigeto Matsushita
- Department of Dermato‐Oncology/DermatologyNational Hospital Organization Kagoshima Medical CenterKagoshimaJapan
| | - Koji Yoshino
- Department of Dermato‐Oncology/DermatologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Akira Hashimoto
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yusuke Muto
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kentaro Ohuchi
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Ryo Amagai
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yumi Kambayashi
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuhiro Fujisawa
- Department of DermatologyUniversity of TsukubaTsukubaJapan,Department of DermatologyUniversity of EhimeMatsuyamaJapan
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Cojocaru E, Napolitano A, Fisher C, Huang P, Jones RL, Thway K. What's the latest with investigational drugs for soft tissue sarcoma? Expert Opin Investig Drugs 2022; 31:1239-1253. [PMID: 36424693 DOI: 10.1080/13543784.2022.2152324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite extensive research undertaken in the past 20-30 years, the treatment for soft tissue sarcoma (STS) has remained largely the same, with anthracycline-based chemotherapy remaining the first choice for treating advanced or metastatic STS. AREAS COVERED This review focuses on newly approved drugs for STS and current research directions, including recent results of late-phase trials in patients with STS. We cover several different histological subtypes, and we discuss the role of adoptive cell transfer (ACT) therapies for the treatment of synovial and myxoid/round cell (high-grade myxoid) liposarcoma, one of the most promising areas of treatment development to date. We searched clinicaltrials.gov and pubmed.ncbi.nih.gov, as well as recent year proceedings from the annual conferences of the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and Connective Tissue Oncology Society (CTOS). EXPERT OPINION Immune-oncology drugs (IOs) show promise in certain subtypes of STS, but it is recognized that PD-1/PD-L1 axis inhibition is not enough on its own. Better trial stratifications based on the molecular categorization of different subtypes of STS are needed, and more evidence suggests that 'one size fits all' treatment is no longer sustainable in this heterogeneous and aggressive group of tumors.
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Affiliation(s)
- Elena Cojocaru
- Cancer Genetic Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, SW3 6JJ, London, UK.,Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, SW3 6JJ, London, UK
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, SW3 6JJ, London, UK
| | - Cyril Fisher
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Huang
- Protein Networks Team, Division of Molecular Pathology, The Institute of Cancer Research, SW7 3RP, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, SW3 6JJ, London, UK.,Protein Networks Team, Division of Molecular Pathology, The Institute of Cancer Research, SW7 3RP, London, UK
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, SW3 6JJ, London, UK.,Protein Networks Team, Division of Molecular Pathology, The Institute of Cancer Research, SW7 3RP, London, UK
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