Objective: Angiosarcoma of the head and neck is a rare malignancy with poor survival secondary to high local and metastatic recurrence rates. The objectives of this study are to outline the metastatic patterns of this disease and evaluate which surgical interventions provide survival and/or time to recurrence benefits.
Methods: A retrospective chart review was performed on 62 individuals diagnosed with primary angiosarcoma of the scalp and/or face within our health system (3 tertiary care centers) between 1983 and 2015. Findings were assessed using univariate and multivariate analysis.
Results: Within the sample group, the average age was 71 years, 74% were male, and average follow up was 42.4 months. Of this group, 33 (53%) developed metastatic disease. In the metastatic group, 14 (22.6%) were locoregional only, 11 (17.7%) were distant only, and 8 (12.9%) were both locoregional and distant. The most common single sites of metastatic spread were the cervical lymph nodes (21.7% of mets), the parotid gland(s) (23.3% of mets) and the lungs/pleura (18.33% of mets). Given these findings, 2 and 5 year survival (2YS and 5YS) was calculated for patients undergoing no surgery (NS), wide local excision alone (WLE), and wide local excision with parotidectomy and neck dissection (WLEPN). For these respective groups: NS (50% 2YS, 12.50% 5YS), WLE (81.25% 2YS, 50% 5YS), and WLEPN (83.3% 2YS, 20% 5YS). When comparing the 2YS and 5YS of the WLE group and WLEPN group each to the NS group as a control, no statistical difference is seen (p=.07, .215, and .061, .726 respectively). When directly comparing the 2YS and 5YS of the WLE group and WLEPN group, again no statistical difference is seen (p=.91 and p=.22). Average overall survival was compared between the WLEPN group (35.7 months) and all non-surgical patients (19.8 months), however no statistical difference was seen (p=.226). Time to recurrence was compared between the WLEPN group (21.8 months) and a control surgical group that did not undergo parotidectomy/neck dissection (22.36 months). These values were also not found to be statistically different (p=.93)
Conclusion: Though the parotid gland(s) and cervical lymph nodes represent the most common areas of metastasis for angiosarcoma of the scalp and face, performing a parotidectomy and neck dissection at the time of presentation does not appear to provide a survival benefit at 2 years, 5 years or overall. Though the difference in 2 and 5 year survival was not statistically significant, there is certainly a trend towards increased survival in the WLE group and WLEPN group when compared to NS.