Recommendations for therapeutic decisions of angiosarcoma of the scalp and face

The aim of this study was to elucidate the therapeutic decision process of angiosarcoma of the scalp and face including treatment modalities, tumor size, tumor grade, and resection margins. In a PubMed search, 170 abstracts were read and 32 full text articles were reviewed. Among them, 19 articles were analyzed. Overall, survival did not differ significantly between the surgery group (23.6 ± 11.0 months) and the no surgery group (22.2 ± 8.0 months) (P = 0.386 [t test]). Among the patients who had undergone an operation, 64.4% had residual cancer cells at their surgical margin. Survival did not differ significantly according to the positive or negative resection margin (P > 0.05 [t tests]). Overall survival of the radiation therapy and chemotherapy group (37.0 ± 0.0 months) was significantly longer than that of the radiation therapy group (22.7 ± 7.6 months) or the chemotherapy group (15.1 ± 4.6 months). Overall survival, local recurrence-free survival, and distant metastasis-free survival were significantly longer in the T1 group (the tumor size being the same or smaller than 5  cm) than the T2 group (tumor larger than 5  cm) (P < 0.05 [t test]). The 2-year survival rates and the 5-year survival rates were significantly longer in the T1 group than in the T2 group (P < 0.000 [t test]). The overall survival of low grade tumor group (44.8 ± 10.4 months) was more than 2 times longer than the high-grade tumor group (22.3 ± 6.8 months) (P = 0.000 [t test]). Surgeons should remember that they do not have to try to remove all the cancer cells in the operation theater. A combination of radiation and chemotherapy can bring better results than any single regimen. Lastly, early diagnosis and early treatment are essential.