Angiosarcomas: Gaining a Wider Margin of Success

An Interview With Sandra P. D'Angelo, MD

Sandra P. D'Angelo, MD; Shira Berman


October 22, 2013

In This Article

Is There a Role for Adjuvant Chemotherapy?

Medscape: What role does adjuvant chemotherapy play in this disease? What are the decisions that go into determining whether and when to administer adjuvant chemotherapy?

Dr. D'Angelo: The role of adjuvant chemotherapy in the management of all soft-tissue sarcomas is very controversial. There have been multiple studies conducted, but none have demonstrated a survival benefit with the use of adjuvant chemotherapy.[8] That being said, the number of patients in these trials who had the subtype of angiosarcoma has never really been quantified, so we don't really know whether angiosarcoma patients can benefit from chemotherapy.

In our study, we found that use of adjuvant chemotherapy was associated with better outcomes,[3] but it was a retrospective study with many limitations. So we can't claim these data are practice-changing, and we can't use them to recommend adjuvant chemotherapy for all of our patients. Right now, it's just an interesting finding. But learning more about why these particular patients fared better is important, and will help us in the future determine who should receive adjuvant chemotherapy.

For now, in clinical practice, some of the things that play a role in deciding whether chemotherapy might be considered include whether the tumor is > 5 cm, and if it's a primary breast angiosarcoma, and whether it is a high-grade cancer. Ultimately, though, it becomes an individualized decision, weighing the risks and benefits of chemotherapy in each particular patient. If the patient is young, healthy, and fit, with minimal medical problems and has what appears to be a more aggressive tumor, then a discussion of adjuvant chemotherapy is certainly warranted. If the patient has multiple medical problems and is older, and we think it might be difficult to safely administer chemotherapy, it is less likely that chemotherapy will be offered.

The challenge is that there are limited prospective data to support the use of adjuvant chemotherapy. Does giving chemotherapy after surgical resection reduce the risk for recurrence? We don't know the answer to that question. So it really does have to be an individualized discussion.


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