Clinical outcomes following high-dose-rate surface applicator brachytherapy for angiosarcoma 
of scalp and face

Devarati Mitra; Phillip M. Devlin; Ivan Buzurovic; Katherine Thornton; Allen C. Lam; Chandrajit P. Raut; Elizabeth H. Baldini; Miranda B. Lam

doi:10.5114/jcb.2021.105285

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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2/2021
vol. 13

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abstract:

Original paper

Clinical outcomes following high-dose-rate surface applicator brachytherapy for angiosarcoma of scalp and face

Devarati Mitra

¹

,

Phillip M. Devlin

²

,

Ivan Buzurovic

¹

,

Katherine Thornton

³

,

Allen C. Lam

⁴

,

Chandrajit P. Raut

^{5, 6}

,

Elizabeth H. Baldini

^{1, 5}

,

Miranda B. Lam

^{1, 5}

Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
Sarcoma and Bone Cancer Treatment Center, Dana-Farber Cancer Institute, Boston, MA, USA
Department of Surgery, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

J Contemp Brachytherapy 2021; 13, 2: 172–178

DOI: https://doi.org/10.5114/jcb.2021.105285

Online publish date: 2021/04/14

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Introduction
Angiosarcoma is a sub-type of soft tissue sarcoma, often presenting as a multifocal or diffuse disease process with poor prognosis. This study presents outcomes of a single institution cohort of patients with angiosarcoma of the scalp and face following treatment with multimodality therapy, including high-dose-rate surface applicator (HDR-SA) brachytherapy, and represents the largest cohort utilizing this therapeutic approach.

Material and methods
Twenty patients with primary or recurrent angiosarcoma of the face or scalp were treated with HDR-SA brachytherapy between 2003-2018, with clinical characteristics and outcomes collected from medical records and used to identify prognostic features.

Results
Median follow-up was 45 months. Patients treated with HDR-SA brachytherapy had a 4-year local control rate of 63%, a 4-year progression-free survival (PFS) rate of 20%, and a 4-year overall survival rate of 54%. Disease features associated with worse loco-regional control (LRC) included location on the scalp (vs. face, p = 0.04) and tumor size ≥ 5 cm (p = 0.0099). Outcomes after HDR-SA brachytherapy for salvage therapy vs. HDR-SA brachytherapy as a component of an initial treatment approach were also significantly different, with worse LRC (p = 0.0084) and worse overall survival (OS) (p = 0.0019) in a setting of salvage therapy.

Conclusions
Local control rates following HDR-SA brachytherapy for scalp or face angiosarcoma are moderate and similar to what is described in the literature using a variety of local control treatment modalities. Smaller tumors and those involving the face rather than scalp had better outcomes. PFS rates were poor and there is a pressing need for treatment intensification and novel therapeutic options.

keywords:

Clinical outcomes following high-dose-rate surface applicator brachytherapy for angiosarcoma of scalp and face

Devarati Mitra 1 , Phillip M. Devlin 2 , Ivan Buzurovic 1 , Katherine Thornton 3 , Allen C. Lam 4 , Chandrajit P. Raut 5, 6 , Elizabeth H. Baldini 1, 5 , Miranda B. Lam 1, 5

HDR brachytherapy, angiosarcoma

Devarati Mitra

¹

,

Phillip M. Devlin

²

,

Ivan Buzurovic

¹

,

Katherine Thornton

³

,

Allen C. Lam

⁴

,

Chandrajit P. Raut

^{5, 6}

,

Elizabeth H. Baldini

^{1, 5}

,

Miranda B. Lam

^{1, 5}