Bring a large pot of lightly salted water to a boil.
Add pasta and cook for 8 to 10 minutes or until al dente; drain and reserve.
In a large saucepan melt butter over medium low heat; add vodka, red pepper flakes and Worcestershire sauce. Stir well and simmer for 5 minutes.
Blend in tomato sauce, tomato paste and cream; increase heat to bring to a boil. Simmer for 5 minutes or until sauce has slightly thickened; season with salt and pepper to taste.
Reduce heat to very low and stir in cheese; add cooked pasta and more cheese, if desired.