Outcomes of the Treatment of Head and Neck Sarcomas in a Tertiary Referral Center

Abstract

Head and neck sarcomas are a rare and heterogeneous group of tumors that pose management challenges. We report our experience with these tumors. Forty consecutive patients treated for 44 head and neck sarcomas between 1997 and 2014 were culled from our prospectively maintained head and neck database. Five patients were excluded. The adult cohort consisted 29 (83%) patients of a mean age of 57.7 years, with 33 sarcomas. The most common diagnoses were undifferentiated pleomorphic sarcoma (27%) and chondroblastic osteosarcoma (21%). Clear surgical margins were achieved in 24/33 (73%) lesions. Twenty-two patients received radiotherapy and/or chemotherapy. Fourteen patients developed local (n = 6), regional (n = 1) and distant (n = 7) recurrence. The overall 5-year survival was 66% with a mean survival interval of 66.5 months. Recurrent sarcoma, close (<1 mm) or involved surgical margins and advanced age were associated with statistically significantly reduced survival. The pediatric cohort consisted 6 (17%) patients, with a mean age of 9 years. Five patients had primary embryonal rhabdomyosarcomas and one had chondroblastic osteosarcoma. Clear surgical margins were achieved in five (83%) patients. All patients received adjuvant radiotherapy and/or chemotherapy. Mean survival interval was 102 months. Three patients developed local (n = 1) or distant (n = 2) recurrence. Twenty-three free and 8 pedicled flaps were performed in 25 patients. Eleven out of thirty-nine (28%) lesions in 11 patients developed a complication. In conclusion, head and neck sarcomas are best managed by a multidisciplinary team at a tertiary head and neck referral center and resection with clear margins is vital for disease control.

Locally Advanced Osteosarcoma of the Ethmoid Sinus: A Report of Successful Management

“…Negative margins serve as prognostic factors [14]. Local recurrence is more frequent than distant metastases compared to extremity osteosarcoma [8,15].…”

Current update on the diagnosis and management of head and neck soft tissue sarcomas

“…Some authors such as Galy Bernadoy & Garrel suggest this may be due to the distribution of histotypes with more aggressive tumours such as angiosarcoma and fibrosarcoma arising in the head and neck. However, overall generalisations of prognosis can also be difficult due to the heterogeneity of the histotypes . It is also relatively more difficult to achieve clear margins in the head and neck due to the proximity of vital structures and the relatively confined anatomical area.…”

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

“…Sarcomas are uncommon malignant tumors arising from mesenchymal tissue and represent a wide range of histological subtypes. Up to 10% of sarcomas occur in the head and neck region, however, these malignancies account for only 1‐2% of cancer of the head and neck . Given the paucity of head and neck sarcomas, many physicians lack the familiarity and experience to adequately diagnose and treat these diseases promptly and according to best practice guidelines .…”

“…Up to 10% of sarcomas occur in the head and neck region, however, these malignancies account for only 1-2% of cancer of the head and neck. 1,2 Given the paucity of head and neck sarcomas, many physicians lack the familiarity and experience to adequately diagnose and treat these diseases promptly and according to best practice guidelines. 3 Furthermore, data to support the best treatment modalities for this heterogeneous class of tumors in common clinical scenarios are limited to single institution series.…”