A Review of Management and Outcome of Colorectal Angiosarcoma

Purpose: Colorectal angiosarcoma (AS) is a rare aggressive tumour, with no known natural history. We aim to determine the clinical course, management and prognosis of colorectal AS by an analysis of reported cases. Methods: The cases were identified from PubMed, bibliographies of the retrieved papers and included one patient from our hospital. Results: A total of 38 cases, including our one case, were analysed. The median (range) age at presentation was 59 (16-85) years and 55% were women. The most frequent site was sigmoid colon (39%). The size of the tumour ranged from 0.3-12 cms. (median: 5 cms.). The commonest symptom was rectal bleeding in 53%. Metastases were present in 48%, excluding the four cases which itself were metastases from AS at other sites. Surgical resection was carried out in 81%; chemotherapy given in 26% and radiotherapy in 28%. The median and 5-year survival rates were eight months and 2.9% respectively. On univariate analysis age, size of tumour, tumour ? 5 cm., recurrence and presence of metastases were significant but surgical resection including R0 resection, radiotherapy (XRT), chemotherapy and gender were not significant for survival. On multivariate analysis only the presence of metastases was significant. Conclusion: AS has a poor prognosis compared to other colorectal tumours. The review suggests treatment of choice to be complete resection (R0), though because of very few cases published, there is no definite evidence for it. One must be aware of this rare entity, particularly in patient with colorectal malignancy presenting with unusual symptoms.