A case of advanced scalp angiosarcoma successfully treated with combination chemotherapy of adriamycin, cisplatin and ifosfamide

Abstract

Scalp angiosarcoma is a rare and highly malignant tumour originating from endothelial cells of vessels and occurring predominantly in elderly men. Its prognosis is poor and the 5-year survival rate of patients is reported to be 12–33% [1]. Complete surgical excision with wide margins remains the cornerstone of therapy for localised tumours. Additional radiotherapy may provide improved local control. Given the rarity of this tumour, an optimum chemotherapy regimen has not yet been defined for metastatic cases. Here we report a case of scalp angiosarcoma with local recurrence and distant metastases which was successfully treated with a combination chemotherapy consisting of adriamycin, cisplatin, ifosfamide and mesna (APIM). A 24-year-old man presented to a plastic surgeon in January 2005 with a painless nodule on the scalp measuring 3 cm in diameter. Surgical total excision of the nodule was carried out, providing a negative surgical margin (2 cm). The diagnosis of angiosarcoma was confirmed pathologically. An X-ray of the scull, magnetic resonance imaging of the brain and computed tomography of the neck, thorax and abdomen revealed no evidence of local or distant metastases at the time of diagnosis. The patient was not given any adjuvant therapy. Five months after the surgery, the patient developed two new angiosarcoma lesions (1.5 and 2 cm in diameter) on different sites of the scalp. In addition, computed tomography of the neck and chest revealed conglomerate lymph nodes on the left side of the neck and five small metastatic nodules, up to 1.5 cm greatest dimension in bilateral lung fields.