Research
Original Investigation
Angiosarcoma of the Scalp and Face The Mayo Clinic Experience Samir H. Patel, MD; Richard E. Hayden, MD; Michael L. Hinni, MD; William W. Wong, MD; Robert L. Foote, MD; Shadi Milani, BS; Qing Wu, ScD; Stephen J. Ko, MD; Michele Y. Halyard, MD
IMPORTANCE The etiology and optimal treatment are unknown for angiosarcoma, an
aggressive malignant tumor that affects vascular endothelial cells and can be mistaken for benign lesions such as hemangioma. OBJECTIVE To determine the treatment outcomes of patients with angiosarcoma of the face or scalp treated with a combination of surgery, radiation therapy, and/or chemotherapy. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of 55 patients with angiosarcoma of the face or scalp treated between January 1, 1973, and December 31, 2012, at a tertiary-care academic medical institution. INTERVENTIONS Surgery, radiation therapy, and/or chemotherapy. MAIN OUTCOMES AND MEASURES Locoregional control (LRC), recurrence-free survival (RFS),
and overall survival (OS). RESULTS Fifty-five patients had angiosarcoma localized to the face or scalp. Forty of these patients (73%) received a combination of surgery, radiation therapy, and/or chemotherapy. Eight patients (15%) were treated with surgery alone, 1 (2%) with radiation alone, 5 (9%) with chemotherapy alone, and 1 (2%) with observation alone. Median (range) follow-up for surviving patients was 25.2 (4.7-227.1) months. Five-year LRC, RFS, and OS (95% CI) were 18% (7%-32%), 16% (6%-31%), and 38% (21%-54%), respectively. Of 36 patients with failed treatment, 34 had failure in a local and/or regional site. On univariate analysis, the use of multimodality therapy (vs no multimodality therapy) was associated with higher 5-year LRC (95% CI) (20% [3%-37%] vs 11% [0%-29%]; P = .04), higher RFS (19% [2%-36%] vs 10% [0%-27%]; P = .02), and higher OS (46% [26%-66%] vs 16% [0%-43%]; P = .04). Age 70 years or older (vs 5 cm), presence of satellite lesions, nodal disease at diagnosis, date of last follow-up, and pattern of failure (local, regional, distant, or combination). Forty-four patients underwent surgery, which consisted of wide local excision with or without reconstruction. Reconstruction typically consisted of placement of a split-thickness skin graft or rotation flap. Despite attempts to achieve negative margins, including re-resection of positive margins, 12 patients were found to have a positive margin on final pathologic testing. Thirty-seven patients received radiation therapy, which consisted of electron beam or megavoltage photon beam irradiation. Doses ranged from 4000 cGy to 7000 cGy in 10 to 35 fractions. The median dose was 6000 cGy. In the adjuvant setting for negative margins, doses ranged from 4500 cGy to 6000 cGy in 25 to 30 fractions. For positive margins, doses ranged from 6000 cGy to 6600 cGy in 30 to 33 fractions. In the definitive setting, doses typically ranged from 6600 cGy to 7000 cGy in 33 to 35 fractions, with 1 patient receiving 4000 cGy in 10 fractions. Twenty-seven patients received chemotherapy, and chemotherapy details were available for 25 patients, 11 of whom received adjuvant chemotherapy alone (6 paclitaxel based; 1 bevacizumab alone; 2 mitomycin, doxorubicin, and cisplatin; and 2 doxorubicin and ifosfamide). Seven other patients received chemotherapy concurrently with adjuvant radiation therapy (6 paclitaxel and 1 carboplatin). Two patients underwent neoadjuvant chemotherapy, with 1 receiving gemcitabine and docetaxel and 1 receiving paclitaxel and bevacizumab. Five patients underwent chemotherapy alone (4 paclitaxel based and 1 mitomycin, doxorubicin, and cisplatin).
Statistical Methods
Methods Patients and Treatments This retrospective study was approved by the Mayo Clinic Institutional Review Board. Between January 1, 1973, and December 31, 2012, a total of 56 patients with angiosarcoma of the scalp and/or face were treated at Mayo Clinic. One patient was excluded from analysis because of a diagnosis of congenital angiosarcoma at the age of less than 1 year, for a total of 55 patients whose medical records were reviewed for this analysis. Patients had no signs of distant metastatic disease outside the head and neck. Primary therapy in the form of surgery, radiation therapy, chemotherapy, or combination therapy was delivered at Mayo Clinic (Scottsdale, Arizona; Jackson336
Frequencies and percentages were used to describe characteristics of patients, disease, and treatment. Overall survival (OS) was calculated as the time from cancer diagnosis to date of death due to any cause. Recurrence-free survival (RFS) was calculated as the time from cancer diagnosis to earliest date of recurrence or death due to any cause. Locoregional control (LRC) failure was calculated as the time from cancer diagnosis to the date of local or regional failure. Multimodality therapy was defined as any 2 or more modalities (surgery, radiation, and chemotherapy). Kaplan-Meier estimates and plots were used to describe time to event end points overall and by group. Five-year OS, RFS, and LRC failure rates were calculated using the KaplanMeier method, and the difference between patient groups was tested using Wilcoxon tests. Cox regression analysis was used
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Angiosarcoma of the Scalp and Face
Original Investigation Research
Table 1. Characteristics of 55 Patients With Angiosarcoma of the Face or Scalp Treated With Surgery, Radiation Therapy, and/or Chemotherapy at Mayo Clinic (1973-2012) Patients, No. (%)a
Characteristic
Figure 1. Survival in Patients With Angiosarcoma of the Face or Scalp Treated With a Combination of Surgery, Radiation Therapy, and/or Chemotherapy A
Age, y 18 (33)
≥70
37 (67)
Sex Male
39 (71)
Female
16 (29)
Grade (n = 35)b Low
12 (34)
High
23 (66)
Recurrence-Free Survival, %
100
5 cm
14 (41)
Site
0 0
12
24
36
48
60
72
84
96
72
84
96
Months Since Diagnosis B
Scalp
35 (64)
Face
20 (36)
100
No
50 (91)
80
Yes
5 (9)
Nodal disease at diagnosis No
52 (95)
Yes
3 (5)
Local therapy
60
40
20
Surgery alone
8 (15)
Radiation therapy alone
1 (2)
Chemotherapy alone
5 (9)
None
1 (2)
Combination therapy Surgery + radiation therapy
18 (33)
Surgery + chemotherapy
0 0
12
24
36
48
60
Months Since Diagnosis
A, Recurrence-free survival. B, Overall survival. The dashed line is the position for 50% survival rate.
4 (7)
Radiation therapy + chemotherapy
4 (7)
Surgery + radiation therapy + chemotherapy
14 (25)
d
Surgical margin status (n = 38) Positive
12 (32)
Negative
26 (68)
a
N = 55 unless indicated otherwise.
b
Grade not available for 20 patients.
c
Tumor size not assessable for 21 patients.
d
Surgical margin status not assessable for 6 of 44 patients who underwent surgery.
for multivariable analysis. P < .05 was considered statistically significant.
Results Patient characteristics are reported in Table 1. Median (range) follow-up for surviving patients was 25.2 (4.7-227.1) months. Five-year OS was 38% (95% CI, 21%-54%), with a median survival of 25.2 months. Five-year RFS was 16% (95% CI, 6%-31%) jamaotolaryngology.com
Overall Survival, %
Satellites at presentation
and 5-year LRC was 18% (95% CI, 7%-32%). Five-year local control was 38% (95% CI, 22%-54%). Figure 1 summarizes RFS and OS. On univariate analysis, improved OS was associated with the use of combined modality therapy (46% [95% CI, 26%66%]; P = .04). Age younger than 70 years (49% [95% CI, 24%-75%]; P = .04), use of radiation therapy (19% [95% CI, 2%35%]; P = .004), and use of multimodality therapy (19% [95% CI, 2%-36%]; P = .01) were associated with improved RFS. Improved LRC was associated with the same factors of age younger than 70 years (48% [23%-74%]; P = .02), use of radiation therapy (20% [95% CI, 3%-36%]; P = .02), and use of multimodality therapy (20% [95% CI, 3%-37%]; P = .04). Table 2 summarizes the univariate analyses for OS, RFS, and LRC. On multivariable analysis, age younger than 70 years was associated with both improved RFS (49% [95% CI, 24%-75%]; P = .04) and LRC (48% [95% CI, 23%-74%]; P = .03). Table 3 summarizes the multivariable analyses for RFS and LRC. Of the 37 patients 70 years or older, 25 (68%) received multimodality therapy. Twelve patients 70 years or older received single modality therapy, and 5 of those 12 (42%) did not receive multimodality therapy because of comorbidities.
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337
Research Original Investigation
Angiosarcoma of the Scalp and Face
Table 2. Univariate Analysis for Overall Survival (OS), Recurrence-Free Survival (RFS), and Locoregional Control (LRC) in 55 Patients With Angiosarcoma of the Face or Scalp Treated With Surgery, Radiation Therapy, and/or Chemotherapy at Mayo Clinic (1973-2012) Variable
No. of Patients (N = 55)a
5-Year OS, % (95% CI)
P Valueb
5-Year RFS, % (95% CI)
P Valueb
5-Year LRC, % (95% CI)
P Valueb
Age group, y 5
14
29 (2-56)
No
50
37 (19-54)
Yes
5
53 (5-100)
0 (0-0) .44
16 (0-36)
0 (0-0) .92
16 (0-37)
.45
Satellite lesions 18 (4-32) .60
0 (0-0)
19 (5-33) .77
0 (0-0)
.87
Nodal disease No
52
33 (16-51)
Yes
3
100 (100-100)
Margin status
10 (0-22) .17
100 (100-100)
11 (0-24) .08
100 (100-100)
.08
(n = 38)
Negative
26
48 (24-72)
Positive
12
41 (1-82)
No
18
41 (10-73)
Yes
37
37 (17-57)
No
27
33 (11-55)
Yes
28
44 (18-70)
18 (0-38) .54
0 (0-0)
18 (0-38) .70
0 (0-0)
.36
Radiation therapy 12 (0-31) .27
19 (2-35)
12 (0-32) .004
20 (3-36)
.02
Chemotherapy 23 (5-41) .30
8 (0-23)
23 (5-41) .36
10 (0-27)
.52
Surgery No
12
0 (0-0)
Yes
43
43 (24-62)
0 (0-0) .09
19 (4-33)
0 (0-0) .55
19 (5-34)
.58
Location Scalp
35
26 (7-44)
Face
20
64 (38-90)
Multimodality therapy
11 (0-24) .21
12 (0-26) .96
26 (0.1-51)
.59
(n = 54)
No
15
16 (0-43)
Yes
39
46 (26-66)
a
N = 55 unless otherwise indicated.
b
By the Wilcoxon rank sum test.
10 (0-27) .04
Of the 55 patients, 36 had failure after initial therapy. Thirtyfour failures were initially locoregional, with the majority (n = 26) representing local failures. The majority of initial locoregional failures occurred within 36 months (Figure 2). The 2 initial distant failures were in the abdominal wall and lung. Eventual distant metastasis was documented in 5 additional patients. Two patients developed lung metastases, and 1 patient developed lung and bone metastases. One patient developed liver and bone metastases, and 1 patient developed bone metastases only.
Discussion As noted in the earlier Mayo Clinic experience, cutaneous angiosarcoma of the head and neck is a difficult disease to con338
24 (0-49)
19 (2-36)
11 (0-29) .01
20 (3-37)
.04
trol, with most patients not living longer than 5 years.3,9 Our current series further confirms the poor clinical outcomes of patients with cutaneous angiosarcoma of the head and neck. Furthermore, this disease primarily affects fair-skinned elderly men. Our 5-year OS of 38% represents a modest improvement over previous series that reported a 5-year OS ranging from 10% to 30%.10 In our series, 1 patient elected to have no therapy, and 5 patients were treated with chemotherapy alone because of locally extensive disease, which potentially affected the reported OS for this cohort. Our results are comparable to those in more recent publications that suggest a 5-year OS ranging from 33% to 54%.2,7,8 In 2011, Albores-Saavedra et al2 reported on a SEER (Surveillance, Epidemiology, and End Results) analysis of cutaneous angiosarcoma that included 135 cases of the scalp and neck, showing a 5-year and 10-year OS of 33.6% and 13.8%, respec-
JAMA Otolaryngology–Head & Neck Surgery April 2015 Volume 141, Number 4 (Reprinted)
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Angiosarcoma of the Scalp and Face
Original Investigation Research
Table 3. Multivariable Analysis for Recurrence-Free Survival (RFS) and Locoregional Control (LRC) in 55 Patients With Angiosarcoma of the Face or Scalp Treated With Surgery, Radiation Therapy, and/or Chemotherapy at Mayo Clinic (1973-2012) 5-Year RFS, % (95% CI)
P Valueb
5-Year LRC, % (95% CI)
100
P Valueb
Age, y
Original Investigation
Angiosarcoma of the Scalp and Face The Mayo Clinic Experience Samir H. Patel, MD; Richard E. Hayden, MD; Michael L. Hinni, MD; William W. Wong, MD; Robert L. Foote, MD; Shadi Milani, BS; Qing Wu, ScD; Stephen J. Ko, MD; Michele Y. Halyard, MD
IMPORTANCE The etiology and optimal treatment are unknown for angiosarcoma, an
aggressive malignant tumor that affects vascular endothelial cells and can be mistaken for benign lesions such as hemangioma. OBJECTIVE To determine the treatment outcomes of patients with angiosarcoma of the face or scalp treated with a combination of surgery, radiation therapy, and/or chemotherapy. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of 55 patients with angiosarcoma of the face or scalp treated between January 1, 1973, and December 31, 2012, at a tertiary-care academic medical institution. INTERVENTIONS Surgery, radiation therapy, and/or chemotherapy. MAIN OUTCOMES AND MEASURES Locoregional control (LRC), recurrence-free survival (RFS),
and overall survival (OS). RESULTS Fifty-five patients had angiosarcoma localized to the face or scalp. Forty of these patients (73%) received a combination of surgery, radiation therapy, and/or chemotherapy. Eight patients (15%) were treated with surgery alone, 1 (2%) with radiation alone, 5 (9%) with chemotherapy alone, and 1 (2%) with observation alone. Median (range) follow-up for surviving patients was 25.2 (4.7-227.1) months. Five-year LRC, RFS, and OS (95% CI) were 18% (7%-32%), 16% (6%-31%), and 38% (21%-54%), respectively. Of 36 patients with failed treatment, 34 had failure in a local and/or regional site. On univariate analysis, the use of multimodality therapy (vs no multimodality therapy) was associated with higher 5-year LRC (95% CI) (20% [3%-37%] vs 11% [0%-29%]; P = .04), higher RFS (19% [2%-36%] vs 10% [0%-27%]; P = .02), and higher OS (46% [26%-66%] vs 16% [0%-43%]; P = .04). Age 70 years or older (vs 5 cm), presence of satellite lesions, nodal disease at diagnosis, date of last follow-up, and pattern of failure (local, regional, distant, or combination). Forty-four patients underwent surgery, which consisted of wide local excision with or without reconstruction. Reconstruction typically consisted of placement of a split-thickness skin graft or rotation flap. Despite attempts to achieve negative margins, including re-resection of positive margins, 12 patients were found to have a positive margin on final pathologic testing. Thirty-seven patients received radiation therapy, which consisted of electron beam or megavoltage photon beam irradiation. Doses ranged from 4000 cGy to 7000 cGy in 10 to 35 fractions. The median dose was 6000 cGy. In the adjuvant setting for negative margins, doses ranged from 4500 cGy to 6000 cGy in 25 to 30 fractions. For positive margins, doses ranged from 6000 cGy to 6600 cGy in 30 to 33 fractions. In the definitive setting, doses typically ranged from 6600 cGy to 7000 cGy in 33 to 35 fractions, with 1 patient receiving 4000 cGy in 10 fractions. Twenty-seven patients received chemotherapy, and chemotherapy details were available for 25 patients, 11 of whom received adjuvant chemotherapy alone (6 paclitaxel based; 1 bevacizumab alone; 2 mitomycin, doxorubicin, and cisplatin; and 2 doxorubicin and ifosfamide). Seven other patients received chemotherapy concurrently with adjuvant radiation therapy (6 paclitaxel and 1 carboplatin). Two patients underwent neoadjuvant chemotherapy, with 1 receiving gemcitabine and docetaxel and 1 receiving paclitaxel and bevacizumab. Five patients underwent chemotherapy alone (4 paclitaxel based and 1 mitomycin, doxorubicin, and cisplatin).
Statistical Methods
Methods Patients and Treatments This retrospective study was approved by the Mayo Clinic Institutional Review Board. Between January 1, 1973, and December 31, 2012, a total of 56 patients with angiosarcoma of the scalp and/or face were treated at Mayo Clinic. One patient was excluded from analysis because of a diagnosis of congenital angiosarcoma at the age of less than 1 year, for a total of 55 patients whose medical records were reviewed for this analysis. Patients had no signs of distant metastatic disease outside the head and neck. Primary therapy in the form of surgery, radiation therapy, chemotherapy, or combination therapy was delivered at Mayo Clinic (Scottsdale, Arizona; Jackson336
Frequencies and percentages were used to describe characteristics of patients, disease, and treatment. Overall survival (OS) was calculated as the time from cancer diagnosis to date of death due to any cause. Recurrence-free survival (RFS) was calculated as the time from cancer diagnosis to earliest date of recurrence or death due to any cause. Locoregional control (LRC) failure was calculated as the time from cancer diagnosis to the date of local or regional failure. Multimodality therapy was defined as any 2 or more modalities (surgery, radiation, and chemotherapy). Kaplan-Meier estimates and plots were used to describe time to event end points overall and by group. Five-year OS, RFS, and LRC failure rates were calculated using the KaplanMeier method, and the difference between patient groups was tested using Wilcoxon tests. Cox regression analysis was used
JAMA Otolaryngology–Head & Neck Surgery April 2015 Volume 141, Number 4 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archotol.jamanetwork.com/ by a Indiana University School of Medicine User on 05/12/2015
jamaotolaryngology.com
Angiosarcoma of the Scalp and Face
Original Investigation Research
Table 1. Characteristics of 55 Patients With Angiosarcoma of the Face or Scalp Treated With Surgery, Radiation Therapy, and/or Chemotherapy at Mayo Clinic (1973-2012) Patients, No. (%)a
Characteristic
Figure 1. Survival in Patients With Angiosarcoma of the Face or Scalp Treated With a Combination of Surgery, Radiation Therapy, and/or Chemotherapy A
Age, y 18 (33)
≥70
37 (67)
Sex Male
39 (71)
Female
16 (29)
Grade (n = 35)b Low
12 (34)
High
23 (66)
Recurrence-Free Survival, %
100
5 cm
14 (41)
Site
0 0
12
24
36
48
60
72
84
96
72
84
96
Months Since Diagnosis B
Scalp
35 (64)
Face
20 (36)
100
No
50 (91)
80
Yes
5 (9)
Nodal disease at diagnosis No
52 (95)
Yes
3 (5)
Local therapy
60
40
20
Surgery alone
8 (15)
Radiation therapy alone
1 (2)
Chemotherapy alone
5 (9)
None
1 (2)
Combination therapy Surgery + radiation therapy
18 (33)
Surgery + chemotherapy
0 0
12
24
36
48
60
Months Since Diagnosis
A, Recurrence-free survival. B, Overall survival. The dashed line is the position for 50% survival rate.
4 (7)
Radiation therapy + chemotherapy
4 (7)
Surgery + radiation therapy + chemotherapy
14 (25)
d
Surgical margin status (n = 38) Positive
12 (32)
Negative
26 (68)
a
N = 55 unless indicated otherwise.
b
Grade not available for 20 patients.
c
Tumor size not assessable for 21 patients.
d
Surgical margin status not assessable for 6 of 44 patients who underwent surgery.
for multivariable analysis. P < .05 was considered statistically significant.
Results Patient characteristics are reported in Table 1. Median (range) follow-up for surviving patients was 25.2 (4.7-227.1) months. Five-year OS was 38% (95% CI, 21%-54%), with a median survival of 25.2 months. Five-year RFS was 16% (95% CI, 6%-31%) jamaotolaryngology.com
Overall Survival, %
Satellites at presentation
and 5-year LRC was 18% (95% CI, 7%-32%). Five-year local control was 38% (95% CI, 22%-54%). Figure 1 summarizes RFS and OS. On univariate analysis, improved OS was associated with the use of combined modality therapy (46% [95% CI, 26%66%]; P = .04). Age younger than 70 years (49% [95% CI, 24%-75%]; P = .04), use of radiation therapy (19% [95% CI, 2%35%]; P = .004), and use of multimodality therapy (19% [95% CI, 2%-36%]; P = .01) were associated with improved RFS. Improved LRC was associated with the same factors of age younger than 70 years (48% [23%-74%]; P = .02), use of radiation therapy (20% [95% CI, 3%-36%]; P = .02), and use of multimodality therapy (20% [95% CI, 3%-37%]; P = .04). Table 2 summarizes the univariate analyses for OS, RFS, and LRC. On multivariable analysis, age younger than 70 years was associated with both improved RFS (49% [95% CI, 24%-75%]; P = .04) and LRC (48% [95% CI, 23%-74%]; P = .03). Table 3 summarizes the multivariable analyses for RFS and LRC. Of the 37 patients 70 years or older, 25 (68%) received multimodality therapy. Twelve patients 70 years or older received single modality therapy, and 5 of those 12 (42%) did not receive multimodality therapy because of comorbidities.
(Reprinted) JAMA Otolaryngology–Head & Neck Surgery April 2015 Volume 141, Number 4
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337
Research Original Investigation
Angiosarcoma of the Scalp and Face
Table 2. Univariate Analysis for Overall Survival (OS), Recurrence-Free Survival (RFS), and Locoregional Control (LRC) in 55 Patients With Angiosarcoma of the Face or Scalp Treated With Surgery, Radiation Therapy, and/or Chemotherapy at Mayo Clinic (1973-2012) Variable
No. of Patients (N = 55)a
5-Year OS, % (95% CI)
P Valueb
5-Year RFS, % (95% CI)
P Valueb
5-Year LRC, % (95% CI)
P Valueb
Age group, y 5
14
29 (2-56)
No
50
37 (19-54)
Yes
5
53 (5-100)
0 (0-0) .44
16 (0-36)
0 (0-0) .92
16 (0-37)
.45
Satellite lesions 18 (4-32) .60
0 (0-0)
19 (5-33) .77
0 (0-0)
.87
Nodal disease No
52
33 (16-51)
Yes
3
100 (100-100)
Margin status
10 (0-22) .17
100 (100-100)
11 (0-24) .08
100 (100-100)
.08
(n = 38)
Negative
26
48 (24-72)
Positive
12
41 (1-82)
No
18
41 (10-73)
Yes
37
37 (17-57)
No
27
33 (11-55)
Yes
28
44 (18-70)
18 (0-38) .54
0 (0-0)
18 (0-38) .70
0 (0-0)
.36
Radiation therapy 12 (0-31) .27
19 (2-35)
12 (0-32) .004
20 (3-36)
.02
Chemotherapy 23 (5-41) .30
8 (0-23)
23 (5-41) .36
10 (0-27)
.52
Surgery No
12
0 (0-0)
Yes
43
43 (24-62)
0 (0-0) .09
19 (4-33)
0 (0-0) .55
19 (5-34)
.58
Location Scalp
35
26 (7-44)
Face
20
64 (38-90)
Multimodality therapy
11 (0-24) .21
12 (0-26) .96
26 (0.1-51)
.59
(n = 54)
No
15
16 (0-43)
Yes
39
46 (26-66)
a
N = 55 unless otherwise indicated.
b
By the Wilcoxon rank sum test.
10 (0-27) .04
Of the 55 patients, 36 had failure after initial therapy. Thirtyfour failures were initially locoregional, with the majority (n = 26) representing local failures. The majority of initial locoregional failures occurred within 36 months (Figure 2). The 2 initial distant failures were in the abdominal wall and lung. Eventual distant metastasis was documented in 5 additional patients. Two patients developed lung metastases, and 1 patient developed lung and bone metastases. One patient developed liver and bone metastases, and 1 patient developed bone metastases only.
Discussion As noted in the earlier Mayo Clinic experience, cutaneous angiosarcoma of the head and neck is a difficult disease to con338
24 (0-49)
19 (2-36)
11 (0-29) .01
20 (3-37)
.04
trol, with most patients not living longer than 5 years.3,9 Our current series further confirms the poor clinical outcomes of patients with cutaneous angiosarcoma of the head and neck. Furthermore, this disease primarily affects fair-skinned elderly men. Our 5-year OS of 38% represents a modest improvement over previous series that reported a 5-year OS ranging from 10% to 30%.10 In our series, 1 patient elected to have no therapy, and 5 patients were treated with chemotherapy alone because of locally extensive disease, which potentially affected the reported OS for this cohort. Our results are comparable to those in more recent publications that suggest a 5-year OS ranging from 33% to 54%.2,7,8 In 2011, Albores-Saavedra et al2 reported on a SEER (Surveillance, Epidemiology, and End Results) analysis of cutaneous angiosarcoma that included 135 cases of the scalp and neck, showing a 5-year and 10-year OS of 33.6% and 13.8%, respec-
JAMA Otolaryngology–Head & Neck Surgery April 2015 Volume 141, Number 4 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archotol.jamanetwork.com/ by a Indiana University School of Medicine User on 05/12/2015
jamaotolaryngology.com
Angiosarcoma of the Scalp and Face
Original Investigation Research
Table 3. Multivariable Analysis for Recurrence-Free Survival (RFS) and Locoregional Control (LRC) in 55 Patients With Angiosarcoma of the Face or Scalp Treated With Surgery, Radiation Therapy, and/or Chemotherapy at Mayo Clinic (1973-2012) 5-Year RFS, % (95% CI)
P Valueb
5-Year LRC, % (95% CI)
100
P Valueb
Age, y
