The outcomes of cutaneous head and neck angiosarcoma with different treatment modalities and correlation with inflammatory markers.
Authors: Wong Ru Xin , Koh Yen Sin , Yang Valerie Shiwen , Iyer Gopal , Nei Wen Long , Tay Gerald Ci An , Harunal Rashid Mohamad Farid Rin , Chan Jason 
Published: June 2021

e23527 Background: Head and neck angiosarcoma (HN-AS) is a distinct entity that commonly arises from the scalp of elderly Asian males. We strive to study the impact of different treatment modalities and explore correlation with blood inflammatory markers. Methods: A prospectively maintained database was queried for patients with biopsy-confirmed HN-AS treated in a single tertiary institution from 2000 to 2018. Results: Eight-eight patients were analyzed. Median age is 73.5 (IQR 66-81.2). Fifty-five (64%) were non-metastatic at diagnosis, seventy-four (84.1%) arose from the scalp and 70.5% were males. Of the 55 non-metastatic patients, 21 received curative surgery and 7 patients received adjuvant radiotherapy. Patients who had curative surgery had smaller tumors (p < 0.001). Local relapses were 57.1% vs 35.7% without and with radiotherapy (p = 0.34). Five patients were still alive at time of analysis but only 1 with a follow up of more than 5 years. In this group, 2-year and 5-year locoregional progression free survival (PFS) were 56.0% and 26.1%, distant PFS were 73.7% and 41.4%, OS were 48.6% and 17.7%. In the group that was metastatic at presentation (n = 31), 17 patients received palliative chemotherapy with 7 patients documented as partial response. 17 patients received palliative radiotherapy with largely good symptomatic relief. Six patients received photodynamic therapy: with 1 documented abscopal response. The median survival is 6.9 months. Overall, 64 patients received palliative chemotherapy and 42 received palliative radiotherapy (in the metastatic or inoperable setting). The most common chemotherapy regimen was single agent paclitaxel (56.3%). In the first line setting, 66.7% experienced at least a partial response to chemotherapy. Comparing the 3 different treatment groups (metastastic vs curative surgery vs non-metastatic/no curative surgery), patient with curative surgery had the best OS (p = 0.007) but worse PFS compared to non-metastatic but no curative surgery patients (p = 0.03). Using full blood count at diagnosis, hazard ratio for neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) were 1.02 (p = 0.06) and 0.80 (p = 0.02) respectively for OS. In multivariate analysis, age, stage and LMR were the only 3 significant predictors for OS. Conclusions: Cutaneous HN-AS is an aggressive disease. Although patients who had curative surgery had better overall survival which could be confounded by smaller tumours, and they also had earlier documented relapses possibly due to closer surveillance or tumor growth promotion from post-surgical inflammatory response. The value of adjuvant radiotherapy is unknown. Palliative radiotherapy is useful, and a more hypo-fractionated approach should be favored. Palliative single-agent paclitaxel is effective although overall survival remains grave. Blood inflammatory indicators correlate with survival.