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Scalp or face angiosarcoma is a rare cutaneous malignancy with a poor prognosis. Combined therapy including whole scalp radiotherapy (RT) is the treatment for scalp or face angiosarcoma, and volumetric modulated arc therapy (VMAT) is considered to have benefits for target coverage and shorter treatment time.  We reviewed the patients with scalp or face angiosarcoma treated with VMAT at several institutions.

Between January 2015 and March 2020, patients with scalp or face angiosarcoma without distant metastasis treated with VMAT at three institutions were evaluated. Both definitive RT and postoperative RT were included. Information regarding patient status, tumor characteristics, treatment characteristics, and outcomes were obtained from the clinical records. Local control probability (LC), overall survival (OS), and progression-free survival (PFS) were calculated by the Kaplan-Meier method from the start date of any first treatment for angiosarcoma. Toxicity was evaluated by CTCAE version 5.0.

Fifteen patients, 5 patients each from three institutions were included in this study (Table 1). Definitive RT and postoperative RT was performed for 10 and 5 patients. Surgical excision was performed with a 0-2 cm margin. Besides 1 patient, all patients were treated with VMAT; 2-4 arcs with 4 MV or 6 MV photons. One patient was treated with VMAT and electron boost. The frequent dose and fractions were 70Gy in 35 fractions. The clinical target volume (CTV) was whole scalp for 11 patients, whole scalp plus prophylactic lymph node for 3 patients, and extended primary site for 1 patient. The planning target volume (PTV) was CTV with a margin of 3-5 mm in all directions. Induction, concurrent, and maintenance systematic therapy was administered for 9, 14, and 12 patients. The most frequent regimen of systematic therapy was weekly paclitaxel. The median follow-up time was 15.7 months and 8 patients were alive at analysis. The one-year LC was 86% (Figure 1). The one-year OS and PFS were 66.7% and 53.3% (Figure 2). Recurrence was observed in 9 patients; 5 patients had local recurrence, and 7 patients had distant metastasis. For acute non-hematologic toxicity, grade 3 dermatitis, mucositis, and hyponatremia occurred for 12, 1, and 1 patients. For late toxicity, grade 3 and 5 skin ulceration was observed in 4 and 1 patients. The patient with grade 5 skin ulceration died because of infection by Pseudomonas aeruginosa from ulceration. Any other grade 3 or higher non-hematologic toxicities were not observed.

Table 1 Patient and tumor characteristics

The outcome of the patients with scalp or face angiosarcoma treated with VMAT was acceptable.