Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database

Abstract

Background Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. Methods Patients (n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin. Results Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. Conclusion PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.

IRAK2, an IL1R/TLR Immune Mediator, Enhances Radiosensitivity via Modulating Caspase 8/3-Mediated Apoptosis in Oral Squamous Cell Carcinoma

“…At the latest audit in 2018, the overall data-consisting rate was 99.5%. For each involved patient, the following clinicopathological factors were retrospectively retrieved from the database: age, RT dose, pathologic stage, clinical stage, surgical margin, and postoperative adjuvant chemotherapy ( 17 – 19 ). All data were independently validated by a radiation physician and analyzed by a biostatistician according to methods described in the statistical section, as previously reported ( 12 ).…”

Radiation Therapy in Adult Soft Tissue Sarcoma—Current Knowledge and Future Directions: A Review and Expert Opinion

“…Recently, several large population-based analyses were performed to overcome the limitations of small patient numbers and to clarify the value of additional RT (although limited by the inclusion of varying proportions of pediatric sarcomas, bone sarcomas or sarcoma-like histologies). Cannon et al [53] analyzed 1142 patients from the NCDB with margin-positive resections and found a significant benefit regarding 5-year-OS for the addition of radiation (57% vs. 48%). Subgroup analyses revealed that the benefit was found after microscopic and macroscopic incomplete resections with a similar magnitude (R1: 57% vs. 49%, R2: 57% vs. 41%) and was confirmed as an independent prognostic factor after controlling for other covariates which influenced OS according to multivariate analysis.…”

Adjuvant Radiation Therapy for Thoracic Soft Tissue Sarcomas: A Population-Based Analysis

“…24 Similarly, single institutional reports and studies using large datasets from 2 different cancer registries (Surveillance, Epidemiology, and End Results database and NCDB) have shown significant survival benefits of adjuvant RT for patients with head and neck sarcomas and extremity STSs, particularly in cases with high-grade tumors. 13,14,[25][26][27][28] Furthermore, a recent meta-analysis also concluded that RT is associated with lower long-term mortality in patients with surgically resected STSs when the results of high-quality studies (reporting adjusted HRs) are pooled. 29 For thoracic STSs, however, only a limited number of studies have reported single institution-based experiences regarding survival outcomes after adjuvant RT.…”