Case and Research Letter
Unresectable Angiosarcoma Treated With Bevacizumab and Paclitaxel
Angiosarcoma irresecable tratado con bevacizumab y paclitaxel
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Note the erythematous surface, which is papilliform in appearance, and abundant exudate. Several larvae can be seen on the surface of the lesion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Aguado Lobo, A. Hernández-Núñez, M. Isabel García-Arata, J. Borbujo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Aguado Lobo" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Hernández-Núñez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Isabel García-Arata" ] 3 => array:2 [ "nombre" => "J." 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"apellidos" => "Ruíz Bravo-Burguillos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013003761" "doi" => "10.1016/j.ad.2013.10.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003761?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001103?idApp=UINPBA000044" "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001103/v1_201405281018/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Unresectable Angiosarcoma Treated With Bevacizumab and Paclitaxel" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "520" "paginaFinal" => "522" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.V. Nespereira-Jato, C. Peña-Panabad, M. Quindós-Varela, J. García-Silva" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.V." "apellidos" => "Nespereira-Jato" "email" => array:1 [ 0 => "vnespereira@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Peña-Panabad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Quindós-Varela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "García-Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología Hospital Abente y Lago, Complejo Hospitalario Universitario, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología, Hospital Abente y Lago, Complejo Hospitalario Universitario, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angiosarcoma irresecable tratado con bevacizumab y paclitaxel" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 928 "Ancho" => 901 "Tamanyo" => 128939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous violaceous tumor with a 4-cm diameter and peripheral macular lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Angiosarcoma is an aggressive tumor of endothelial origin that is associated with a poor prognosis. The effectiveness of new treatments such as bevacizumab is based on their ability to inhibit angiogenesis; specifically, bevacizumab acts on vascular endothelial growth factor (VEGF), which has been implicated in the pathogenesis of angiosarcoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 68-year-old woman who consulted for an erythematous violaceous tumor with a diameter of 1<span class="elsevierStyleHsp" style=""></span>cm on the scalp. Skin biopsy was consistent with a poorly differentiated angiosarcoma. The lesion grew rapidly and within a month it had progressed to a multilobulated, ulcerated tumor affecting the left side of the scalp and the right occipital region; also present in this region were red wine–colored macules measuring 1 to 2<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A computed tomography (CT) scan ruled out distant disease and the patient was diagnosed with poorly differentiated angiosarcoma (T2b, N0, M0), classified as stage III according to the 2010 American Joint Committee on Cancer staging system.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Immediate surgical treatment was ruled out due to the size of the lesion, which affected over half of the scalp. The patient was treated with neoadjuvant paclitaxel (80<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span>/wk) and bevacizumab (10<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 weeks) and the lesion responded rapidly (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The treatment was completed after 14 cycles (each consisting of 1 bevacizumab infusion and 2 paclitaxel infusions) and was well tolerated. The remaining lesion was surgically removed, and no evidence of angiosarcoma was seen on histology. Despite the negative biopsy results for the area of the tumor, the patient was administered adjuvant radiation therapy (daily fractions of 2<span class="elsevierStyleHsp" style=""></span>Gy, up to a total dose of 50<span class="elsevierStyleHsp" style=""></span>Gy) combined with bevacizumab (5<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 weeks) due to the persistence of a red wine–colored macule in the left preauricular region. Complete response continued following completion of the 2 treatments.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Two months later, however, the patient's general health deteriorated and clinical recurrence of the angiosarcoma was noted in the left preauricular region. The CT scan showed bone metastasis. Combined treatment with paclitaxel and bevacizumab was reinitiated, but the disease progressed and the patient died 14 months after diagnosis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Angiosarcoma is a rare but very aggressive tumor with high metastatic potential. There are 3 forms, but angiosarcoma of the head and neck–the classic form–is the most common.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The treatment of choice is surgical excision with wide margins followed by adjuvant high-dose wide-field radiotherapy (><span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>Gy).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a> Chemotherapy, however, is the only option for patients with advanced or unresectable angiosarcoma, but the effectiveness of different regimens has not been demonstrated in clinical trials.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Additionally, chemotherapy is often limited because of its toxicity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most widely used regimens are anthracyclines and taxanes, but response is limited. Prospective studies of paclitaxel in the treatment of cutaneous angiosarcoma have shown a mean survival time of 8 months and a mean disease-free period of 4 months.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The need for new drugs with improved effectiveness and tolerance is thus clear. Interest is currently focused on angiogenesis inhibitors.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Angiosarcoma originates from vascular endothelial cells, and several factors have been implicated in its pathogenesis. One of the most important of these is VEGF-A,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> which is a growth factor involved in the development of new blood vessels through the stimulation of receptors with tyrosine-kinase activity on the surface of endothelial cells. VEGF-A overexpression by neoplastic cells, which has been demonstrated in angiosarcoma and other tumors (of the lung, breast, and colon/rectum) promotes angiogenesis and consequently leads to increased blood supply and faster tumor growth.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> Bevacizumab is a monoclonal antibody that targets VEGF-A, preventing it from binding to its receptor, and thereby inhibiting angiogenesis. Nonetheless, the potential for recurrence and the short disease-free periods observed suggest that there are other factors at play and that VEGF inhibition alone is not sufficient to stop the tumor from growing.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Five cases of cutaneous angiosarcoma treated with bevacizumab, alone or in combination, have been reported to date. A favorable response was reported in all cases, with good tolerance and longer survival than that seen with other treatments (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The results of the first phase II clinical trial on the use of bevacizumab alone to treat metastatic or locally advanced angiosarcoma were recently published by Agulnik et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The results are promising, as half of the patients showed stable disease with a mean time to disease progression of 26 weeks.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Considering the scarcity of effective treatments and the results reported to date for bevacizumab in isolated cases and clinical trials, we believe that this drug could be considered in cases similar to the one we have presented. There are also clear indications that bevacizumab used in combination with other drugs could improve the prognosis in patients with angiosarcoma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Nespereira-Jato MV, Peña-Panabad C, Quindós-Varela M, García-Silva J. Angiosarcoma irresecable tratado con bevacizumab y paclitaxel. Actas Dermosifiliogr. 2014;105:526–528.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 928 "Ancho" => 901 "Tamanyo" => 128939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous violaceous tumor with a 4-cm diameter and peripheral macular lesions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 683 "Ancho" => 901 "Tamanyo" => 113749 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Photograph of lesion after completion of treatment with bevacizumab and paclitaxel.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: AS, angiosarcoma; ND, no data; DFS, disease-free survival; OS, overall survival.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No. of Cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tumor Site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bevacizumab Doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Other Treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">DFS, mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OS, mo \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Koontz et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5063 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-AS T1N0M0Epithelioid AS T2N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FaceFace \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 wk; 4 doses10<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 wk; 3 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>surgeryRT<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">><span class="elsevierStyleHsp" style=""></span>26<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NDND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rosen et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AS (ND on TNM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Face \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 wk, 14 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fuller et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AS T2bN0M0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Face and neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paclitaxel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">><span class="elsevierStyleHsp" style=""></span>11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">De Yao et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AS T2bN0M0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scalp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 wk, 4 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AS T2bN0M0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scalp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>mg/kg every 2 wk; 14 doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab508510.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of Angiosarcoma (AS) Treated With Bevacizumab in the Literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiosarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. Young" 1 => "N.J. Brown" 2 => "M.W. Reed" 3 => "D. Hughes" 4 => "P.J. Woll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(10)70023-1" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "983" "paginaFinal" => "991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20537949" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An open-label, multicenter, phase <span class="elsevierStyleSmallCaps">ii</span> study of bevacizumab for the treatment of angiosarcoma and epithelioid hemangioendotheliomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Agulnik" 1 => "J.L. Yarber" 2 => "A.H. Okuno" 3 => "M. von Mehren" 4 => "B.D. Jovanovic" 5 => "B.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 12 | 27 |
| 2024 October | 108 | 57 | 165 |
| 2024 September | 98 | 30 | 128 |
| 2024 August | 114 | 36 | 150 |
| 2024 July | 88 | 42 | 130 |
| 2024 June | 89 | 31 | 120 |
| 2024 May | 92 | 28 | 120 |
| 2024 April | 79 | 34 | 113 |
| 2024 March | 87 | 32 | 119 |
| 2024 February | 67 | 30 | 97 |
| 2024 January | 61 | 46 | 107 |
| 2023 December | 64 | 100 | 164 |
| 2023 November | 65 | 26 | 91 |
| 2023 October | 83 | 28 | 111 |
| 2023 September | 74 | 29 | 103 |
| 2023 August | 57 | 11 | 68 |
| 2023 July | 79 | 33 | 112 |
| 2023 June | 75 | 25 | 100 |
| 2023 May | 95 | 22 | 117 |
| 2023 April | 49 | 18 | 67 |
| 2023 March | 61 | 25 | 86 |
| 2023 February | 42 | 28 | 70 |
| 2023 January | 41 | 23 | 64 |
| 2022 December | 47 | 40 | 87 |
| 2022 November | 37 | 26 | 63 |
| 2022 October | 30 | 21 | 51 |
| 2022 September | 29 | 39 | 68 |
| 2022 August | 23 | 29 | 52 |
| 2022 July | 35 | 40 | 75 |
| 2022 June | 33 | 20 | 53 |
| 2022 May | 39 | 39 | 78 |
| 2022 April | 47 | 39 | 86 |
| 2022 March | 50 | 54 | 104 |
| 2022 February | 29 | 22 | 51 |
| 2022 January | 37 | 37 | 74 |
| 2021 December | 29 | 28 | 57 |
| 2021 November | 39 | 53 | 92 |
| 2021 October | 32 | 38 | 70 |
| 2021 September | 35 | 28 | 63 |
| 2021 August | 34 | 31 | 65 |
| 2021 July | 27 | 29 | 56 |
| 2021 June | 38 | 21 | 59 |
| 2021 May | 29 | 30 | 59 |
| 2021 April | 52 | 35 | 87 |
| 2021 March | 57 | 16 | 73 |
| 2021 February | 54 | 26 | 80 |
| 2021 January | 41 | 12 | 53 |
| 2020 December | 33 | 14 | 47 |
| 2020 November | 21 | 15 | 36 |
| 2020 October | 26 | 12 | 38 |
| 2020 September | 42 | 10 | 52 |
| 2020 August | 29 | 17 | 46 |
| 2020 July | 28 | 18 | 46 |
| 2020 June | 24 | 19 | 43 |
| 2020 May | 25 | 12 | 37 |
| 2020 April | 27 | 16 | 43 |
| 2020 March | 25 | 11 | 36 |
| 2020 February | 4 | 3 | 7 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 1 | 9 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 2 | 0 | 2 |
| 2019 June | 5 | 12 | 17 |
| 2019 May | 1 | 6 | 7 |
| 2019 April | 0 | 10 | 10 |
| 2019 March | 2 | 5 | 7 |
| 2019 February | 0 | 1 | 1 |
| 2019 January | 2 | 1 | 3 |
| 2018 December | 0 | 1 | 1 |
| 2018 November | 1 | 3 | 4 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 4 | 4 |
| 2018 March | 0 | 2 | 2 |
| 2018 February | 33 | 3 | 36 |
| 2018 January | 26 | 6 | 32 |
| 2017 December | 36 | 9 | 45 |
| 2017 November | 30 | 3 | 33 |
| 2017 October | 31 | 4 | 35 |
| 2017 September | 50 | 3 | 53 |
| 2017 August | 53 | 14 | 67 |
| 2017 July | 54 | 18 | 72 |
| 2017 June | 61 | 10 | 71 |
| 2017 May | 58 | 11 | 69 |
| 2017 April | 64 | 4 | 68 |
| 2017 March | 39 | 33 | 72 |
| 2017 February | 36 | 11 | 47 |
| 2017 January | 29 | 9 | 38 |
| 2016 December | 40 | 18 | 58 |
| 2016 November | 54 | 14 | 68 |
| 2016 October | 57 | 8 | 65 |
| 2016 September | 71 | 11 | 82 |
| 2016 August | 61 | 7 | 68 |
| 2016 July | 36 | 4 | 40 |
| 2016 June | 6 | 9 | 15 |
| 2016 May | 5 | 2 | 7 |
| 2016 April | 1 | 15 | 16 |
| 2016 March | 6 | 7 | 13 |
| 2016 February | 12 | 1 | 13 |
| 2016 January | 12 | 4 | 16 |
| 2015 December | 12 | 3 | 15 |
| 2015 November | 10 | 10 | 20 |
| 2015 October | 9 | 16 | 25 |
| 2015 September | 8 | 6 | 14 |
| 2015 August | 16 | 3 | 19 |
| 2015 July | 88 | 5 | 93 |
| 2015 June | 59 | 4 | 63 |
| 2015 May | 49 | 9 | 58 |
| 2015 April | 54 | 14 | 68 |
| 2015 March | 60 | 5 | 65 |
| 2015 February | 45 | 4 | 49 |
| 2015 January | 32 | 7 | 39 |
| 2014 December | 42 | 4 | 46 |
| 2014 November | 36 | 10 | 46 |
| 2014 October | 34 | 3 | 37 |
| 2014 September | 32 | 8 | 40 |
| 2014 August | 30 | 10 | 40 |
| 2014 July | 21 | 13 | 34 |
| 2014 June | 29 | 6 | 35 |
| 2014 May | 3 | 1 | 4 |
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