Neoadjuvant radiation for cutaneous and soft tissue angiosarcoma

• Published in: Journal of surgical oncology Vol. 125; no. 3; pp. 509 - 515
• Main Authors: Sharon, Cimarron E., Straker, Richard J., Shannon, Adrienne B., Shabason, Jacob E., Zhang, Paul J. L., Fraker, Douglas L., Miura, John T., Karakousis, Giorgos C.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2022
• Subjects: Aged; Aged, 80 and over; angiosarcoma; Cancer surgery; Databases, Factual; Female; Hemangiosarcoma - mortality; Hemangiosarcoma - radiotherapy; Hemangiosarcoma - surgery; Humans; Male; Middle Aged; Neoadjuvant Therapy; radiation; Radiation therapy; Radiotherapy, Adjuvant; Retrospective Studies; Sarcoma; Skin Neoplasms - mortality; Skin Neoplasms - radiotherapy; Skin Neoplasms - surgery; Soft Tissue Neoplasms - mortality; Soft Tissue Neoplasms - radiotherapy; Soft Tissue Neoplasms - surgery; surgical margins; angiosarcoma; radiation; surgical margins; neoadjuvant therapy
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.26727

Background and Objectives
Neoadjuvant radiation (NRT) is frequently utilized in soft tissue sarcomas to increase local control. Its utility in cutaneous and soft tissue angiosarcoma remains poorly defined.
Methods
This retrospective cohort study was performed using the National Cancer Database (2004–2016) evaluating patients with clinically localized, surgically resected angiosarcomas. Factors associated with receipt of NRT in the overall cohort and margin positivity in treatment naïve patients were identified by univariate and multivariable logistic regression analyses. Survival was assessed using Kaplan–Meier analysis.
Results
Of 597 patients, 27 (4.5%) received NRT. Increasing age (odds ratio [OR] 0.95, p = 0.025), tumor size more than or equal to 5 cm (OR 3.16, p = 0.02), and extremity tumor location (OR 3.99, p = 0.04) were associated with receipt of NRT. All patients who received NRT achieved an R0 resection (p = 0.03) compared with 17.9% of patients without NRT. Factors associated with risk of margin positivity included tumor size more than or equal to 5 cm (OR 1.85, p = 0.01), and head/neck location (OR 2.24, p = 0.006). NRT was not significantly associated with improved survival (p = 0.21).
Conclusions
NRT improves rates of R0 resection but is infrequently utilized in cutaneous and soft tissue angiosarcoma. Increased usage of NRT, particularly for patients with lesions more than or equal to 5 cm, or head and neck location, may help achieve complete resections.