CUTANEOUS ANGIOSARCOMA OF THE HEAD AND NECK - A THERAPEUTIC DILEMMA

Background. Because of a tendency for diffuse, clinically undetectable local spread, cutaneous angiosarcoma is difficult to treat with surge ry alone. Radiation is a rational treatment modality for this disease, because a wide region of dermis can be treated, whereas the underlyin g normal tissues are spared. Methods. The authors retrospectively stud ied 14 patients with dermal angiosarcoma of the head and neck who were treated with electron-beam radiation from 1970 to 1989. Primary tumor s were located in the scalp and forehead (11 patients) and in the uppe r face (3 patients). Eleven patients presented with multiple foci of d isease, Three patients were treated with radiotherapy alone; the other 11 were treated with chemotherapy (10 patients) and/or surgery (7 pat ients). Surgical excisions were limited procedures for patients whose disease readily could be encompassed; total scalp resections were not performed, Patients were irradiated with a multiple-field electron-bea m technique, Six patients presented postoperatively for radiotherapy w ith no macroscopic disease in the treatment field and were given a med ian dose of 60 Gy (range, 50-66 Gy) over a median of 40 days (range, 3 7-43 days). Eight patients were irradiated with clinically evident dis ease; doses ranged from 55 to 75 Gy over a median of 44 days (range, 3 3-66 days). Results. Five of the six patients irradiated without clini cally detectable disease were controlled in the treatment held, but on ly two are currently disease free. Of the eight patients irradiated wi th macroscopic tumor, initial disease recurrence occurred in the radia tion field in two patients and at the radiation field margin in three patients. The actuarial 5-year central rates above the clavicles for p atients irradiated with and without clinical disease were 24% and 40%, respectively (P = 0.03), The 5-year actuarial incidence of distant me tastases for all patients was 63%. The 5-year actuarial survival rate for patients irradiated with and without clinical disease was 13% and 50%, respectively (P = .04). Conclusions. Radiation is an effective mo dality for treating local disease, especially when used after surgical resection of macroscopic tumor. Our current strategy is to resect cli nically evident tumor in patients presenting with focal, limited disea se, and to follow this resection with moderate dose, very wide-held ra diation. The survival outcome for patients presenting with diffuse mul tifocal disease is bleak, but some patients can be controlled infield with radiation. There must be continued efforts to develop effective s ystemic therapy.