ANGIOSARCOMA OF THE HEAD AND NECK

BACKGROUND: Angiosarcoma (AS) is an uncommon, highly aggressive tumor with a poor prognosis. METHODS: To study the impact of various treatme nt modalities, namely surgery, radiation, and chemotherapy, we reviewe d our experience with AS of the head and neck. RESULTS: From 1978 thro ugh 1992, we treated 13 men and 5 women with AS (median age 67 years). Sixteen tumors occurred on the scalp and face and 2 in the oropharynx . Two patients presented with cervical metastases, and a third had sub sequent nodal involvement. Primary surgery was used in 9 patients, inc luding 1 who received adjunctive systemic doxorubicin hydrochloride, a nd 2 who received adjunctive radiotherapy. The tumors of 9 patients we re unresectable: 4 were treated with intra-arterial doxorubicin hydroc hloride; and 5, with systemic doxorubicin hydrochloride. Twelve patien ts (67%) died of disease an average of 25 months after diagnosis. Over all 5-year survival was 33%, but only 20% of the patients were disease free. Size of the tumor was an important predictor of survival, as al l patients with a lesion >10 cm died of disease, compared with 67% wit h a lesion <10 cm. Four of 6 patients treated with wide local excision for lesions <10 cm survived 5 years. CONCLUSIONS: We recommend surger y for resectable lesions with postoperative radiation for unsatisfacto ry margins, large tumor size, deep extension, and multicentricity, Ele ctive treatment of the neck does not appear warranted.