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The Management and Prognosis of Facial and Scalp Angiosarcoma

A Retrospective Analysis of 15 Patients

Alqumber, Nedhal A. MD*; Choi, Jong-Woo MD, PhD; Kang, Min-kyu MD

doi: 10.1097/SAP.0000000000001865
Head and Neck Surgery
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Background Angiosarcomas are extremely aggressive malignant tumors that arise from vascular endothelial cells. The risk factors, etiology, prognostic factors, and optimal management strategies for angiosarcomas are as yet unknown.

Methods We retrospectively analyzed data from 15 patients who were treated in Asan Medical Center, Seoul, Republic of Korea, in the past 12 years, to assess the effect of different treatment modalities and reconstructive methods on the locoregional recurrence, metastasis, and overall survival.

Results A total of 15 patients were identified (median age at diagnosis, 72 years; range, 61–82 years). Median tumor size was 6 cm. Median follow-up was 287 days. The median overall survival was 14.96 months; a total of 13 (87%) patients had died by the end of the study.

The median locoregional recurrence, metastasis, and overall survival were 7.3, 6.5, and 16.7 months, respectively. On univariate analysis, the use of adjuvant therapy after surgery (vs surgery without adjuvant therapy) was associated with delayed median time to detection of recurrence (7.9 months vs 3.1 months, respectively; P = 0.825), delayed median time to metastasis (8.7 months vs 3.1 months, respectively; P = 0.191), and better median overall survival (7.3 months vs 3.1 months, respectively; P = 0.078).

The use of flap versus skin graft as a reconstructive method was associated with delayed median recurrence (8.75 vs 7.32 months, respectively; P = 0.274) and earlier median metastasis (3.75 vs 6.53 months, respectively; P = 0.365), but the same median overall survival of 16.7 months (P value: 0.945) and tumor smaller or bigger than 5 cm show earlier median time to detection of recurrence (4.17-7.32 months; P = 0.41), earlier median time to metastasis (3.75-6.53 months; P = 0.651), but better median overall survival of 18.21 versus 16.7 months, respectively (P = 0.111).

Conclusions Multimodal treatment that combines surgery with adjuvant therapy is the best management strategy that influences survival positively in patients with angiosarcoma. The study shows that the reconstructive method does not affect the prognosis in these patients. So it is better to choose the simplest suitable resection and reconstructive method with the least complications and to avoid unnecessary procedures.

From the *Department of Plastic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; and

Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea.

Received June 29, 2018, and accepted for publication, after revision January 4, 2019.

Conflict of interest and source of funding: none declared.

Reprints: Jong-Woo Choi, MD, PhD, Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Seoul Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea. E-mail: pschoi@amc.seoul.kr.

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