Cutaneous Angiosarcoma: A Single-Institution Experience

Abstract

Cutaneous angiosarcoma (CAS) is a rare, aggressive vascular sarcoma with a poor prognosis, historically associated with 5-year overall survival (OS) rates between 10 and 30%. This is a single-institution retrospective review of patients treated for CAS from 1999-2011. Demographics, primary tumor characteristics, treatment, and outcomes were analyzed. A total of 88 patients were identified (median age 70years and 57% female). Median tumor size was 3cm. Median follow-up was 22months. The 5-year OS and recurrence-free survival (RFS) were 35.2 and 32.3%, respectively; median was 22.1months. Also, 36 patients (41%) received surgery alone, 7 (8%) received XRT alone, and 41 (47%) received surgery and XRT. Of the 67 of 88 patients who were disease-free after treatment, 33 (50%) recurred (median of 12.3months). Surgery alone had the highest 5-year OS (46.9%) and RFS (39.9%) (p=ns). Four presentation groups were identified: (1) XRT-induced, n=30 (34%), 26 of 30 occurred in females with a prior breast cancer, (2) sporadic CAS on head and neck (H/N), n=38, (3) sporadic CAS on trunk/extremities, n=13, and (4) Stewart-Treves n=7. Those with trunk/extremity CAS had the highest 5-year OS (64.8%), with H/N CAS having the worst 5-year OS (21.5%). On MV analysis, only tumor size <5cm correlated with improved OS (p=0.014). In this large series, there appears to be a better overall prognosis than historically reported, especially in Stewart-Treves and CAS on trunk or extremities. While surgery alone was associated with better OS and RFS compared with other treatment modalities, this was not statistically significant. Tumor size was a significant prognostic factor for OS.