Angiosarcoma of the face and scalp: effective systemic treatment in the older patient

Angiosarcoma of the face and scalp, though rare, frequently affects older people and the prognosis is poor. Due to its rarity, optimal management of advanced disease with chemotherapy has been difficult to define.

This is a retrospective review of patients treated at the Royal Marsden Hospital (RMH), looking at chemotherapy regimens, toxicity profile and treatment outcome in this elderly population over the last 20years.

Detailed clinical-pathologic data were collected on patients treated for head and neck angiosarcoma at RMH between 1992 and 2011.

Thirteen patients (median age: 79years) were eligible for analysis. The majority (92.3%) received taxanes with a response rate of 83.3% and median progression-free survival (PFS) of 7months. Although the main toxicities were lethargy and peripheral neuropathy, a median number of 6 cycles of paclitaxel were administered. Doxorubicin was used in 57% of patients (median number of cycles: 3) with a response rate of 50% (median PFS: 3months). Cardiotoxicity occurred in 2 out of 7 cases and led to discontinuation of treatment. Overall, 57.1% of patients received chemotherapy at least 2 lines of chemotherapy. There were no deaths attributable to systemic treatment.

Advanced angiosarcoma of face and scalp can be controlled with multiple lines of chemotherapy, consisting primarily of taxanes as well as anthracyclines. Old age should not preclude systemic therapy although safety and quality of life issues deserve careful consideration.