Angiosarcoma of the scalp: treatment with liposomal doxorubicin and radiotherapy

Purpose: Angiosarcoma of the scalp and face is a rare malignant endothelial tumor arising mainly in elderly people. The prognosis is poor. Effective a nd safe treatments are warranted. Methods: A 79-year-old woman with an angi osarcoma of the scalp larger than 5 cm in diameter was treated with intrave nous liposomal doxorubicin, 20 mg per square meter body surface (i.e., 30 m g) once per month followed by radiotherapy. Results: After 12 infusions of liposomal doxorubicin, we observed a partial remission with a > 50% decreas e of affected area and disappearance of ulceration. After 21 infusions, how ever, there was no further improvement. We decided to discontinue chemother apy but move on with radiotherapy with an electron beam using fractionated doses of 2 Gy five times per week for up to a total of 40 Gy. To ensure a m aximum dose in the upper layer of the dermis a bolus technique was used. Ra diotherapy was terminated due to a temporary circumscribed epidermolysis. A t the end of treatment a remarkable regression of the cutaneous lesion was noted. During the subsequent 24 months she has not developed any metastatic spread. Conclusion: Sequential therapy of bad prognosis angiosarcoma with liposomal doxorubicin followed by radiotherapy showed a marked clinical imp rovement and prolonged relapse-free survival in this patient.