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Abstract：
Angiosarcoma of the scalp and face (ASF) is a rare, aggressive tumor often treated with multimodal therapy, including radiation therapy (RT). This study assessed RT outcomes for ASF and identified prognostic factors. Data from 68 non-metastatic ASF patients undergoing RT with or without other therapies were analyzed. Median radiation dose was 66 Gy in 33 fractions (interquartile range (IQR) 60-70 Gy in 28-35 fractions). Local control (LC), progression-free survival (PFS), and overall survival (OS) rates were calculated using Kaplan-Meier analysis. Multivariate analyses and adverse event evaluation were conducted. Median patient age was 75 years (IQR 71-80 years), with a median follow-up of 17 months (IQR 11-42 months). One-/three-year LC rates were 57/37%, PFS rates were 44/22%, and OS rates were 81/44%. Multivariate analyses showed that an equivalent dose in a 2 Gy fraction (EQD2) >66 Gy correlated with improved LC (HR 2.35, 95% CI 1.03-5.32, p = 0.041). Combining chemotherapy (HR 2.43, 95% CI 1.08-5.46, p = 0.032) or surgery (HR 2.41, 95% CI 1.03-5.59, p = 0.041) improved PFS. No factors influenced OS. Late grade 3+ toxicities occurred in 1%, with one patient developing a grade 4 skin ulcer. These findings suggest that EQD2 > 66 Gy and combining chemotherapy or surgery can enhance LC or PFS in ASF. Further prospective studies are needed to determine the optimal treatment strategy for this rare malignancy, particularly in elderly patients.
摘要：
头皮和面部血管肉瘤（ASF）是一种罕见的，侵袭性肿瘤通常采用多模式治疗，包括放射治疗（RT）。这项研究评估了ASF的RT结果并确定了预后因素。分析了68例非转移性ASF患者的数据，这些患者接受或不接受其他疗法的RT治疗。在33个部分中，中位辐射剂量为66Gy（四分位距（IQR）在28-35个部分中为60-70Gy）。本地控制（LC），无进展生存期（PFS），使用Kaplan-Meier分析计算总生存率(OS).进行多因素分析和不良事件评价。患者年龄中位数为75岁（IQR71-80岁），中位随访时间为17个月（IQR11-42个月）。一年期/三年期LC率为57/37%，PFS率为44/22%，OS率为81/44%。多变量分析表明，2Gy分数（EQD2）>66Gy的等效剂量与改善的LC相关（HR2.35，95％CI1.03-5.32，p=0.041）。联合化疗（HR2.43，95％CI1.08-5.46，p=0.032）或手术（HR2.41，95％CI1.03-5.59，p=0.041）可改善PFS。没有因素影响OS。晚期3级+毒性发生在1%，一名患者出现4级皮肤溃疡。这些发现表明EQD2>66Gy和联合化疗或手术可以提高ASF的LC或PFS。需要进一步的前瞻性研究来确定这种罕见恶性肿瘤的最佳治疗策略。尤其是老年患者。
