Assessment of Prognostic Factors and Adjuvant Treatment Modalities in Adult Head and Neck Soft Tissue Sarcoma Patients Treated With Upfront Surgery

Abstract

Objectives Head and neck soft tissue sarcomas (HNSTSs) are a heterogeneous group of rare tumors. Surgical resection with negative margins remains the standard primary treatment for patients with HNSTS. The role of chemotherapy (CT) and radiotherapy (RT) remains controversial. In this multicenter study, we aimed to demonstrate the real-world assessing prognostic factors and the effect of adjuvant treatment modalities in adult patients with HNSTS treated with upfront surgery. Methods We included a total of 47 patients who underwent curative-intent resection of a primary HNSTS between 2000 and 2019. Results The median follow-up was 29 months. The median age of patients was 51 years, and 66% of patients were male. The median relapse-free survival (RFS) of the study population was 31 months (range: 1.0-61.1 months), and the median overall survival (OS) was 115 months (range: 60.8-169.2 months). The univariable analysis revealed that treatment modalities showed a significant impact on RFS (p = 0.021); however, no difference was found in its impact on OS (p = 0.137). R0 resection did not showed impact on RFS (p = 0.130), but a significant association was found with OS (p = 0.004). In multivariable analysis, T stage of the tumor (hazard ratio [HR]: 3.834; 95% CI: 1.631-9.008; p = 0.002) and treatment with surgery and sequential RT and CT (HR: 0.115; 95% CI: 0.035-0.371; p < 0.001) were independent factors associated with RFS. R0 resection was independently associated with OS (HR: 4.902; 95% CI: 1.301-18.465; p = 0.019). Conclusion Our study revealed that R0 resection improved OS, and T3-4 stage of tumor was a negative independent factor for RFS in surgically resected HNSTS patients. The use of sequential CT and RT after resection was associated with a better RFS, which emphasizes the importance of multidisciplinary evaluation of the treatment of HNSTS. Randomized prospective studies are needed

Baş ve Boyun Sarkomlarının Klinik Gidişleri ve Özellikleri (Tek Merkez Deneyimi)

“…Bu beş hastanın üçünde akciğer metastazı gelişirken, bir hastada parotis bezine, bir hastada ise akciğer ve kemik olmak üzere birden çok organda metastaz gelişmiştir. Hastalık nüksüne kadar süre geçen süre medyan 11 aydır (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Nüks eden dokuz hastanın dördü tekrar opere edilirken beşi operasyona uygun bulunmamıştır.…”

“…İngiltere'de 49 baş ve boyun yumuşak doku sarkomu hastasına uygulanan cerrahi rezeksiyonu inceleyen bir çalışmada inkomplet rezeksiyon uygulanan hastaların %50'si komple rezeksiyon uygulanan hastaların %18.6'sı nüks etmiştir (5). Türkiye'den yayımlanan 47 hastalık bir çalışmada da R0 rezeksiyonun toplam sağkalımı artırdığı gösterilmiştir (14). Bizim hasta grubumuzda ise cerrahi sınır pozitif olan hastaların %71.4'ü, cerrahi sınır negatif olan hastaların ise %44.4'ünde hastalık tekrarlamıştır.…”

Soft Tissue Sarcomas of the Head and Neck Region with Skull Base/Intracranial Invasion: Review of Surgical Outcomes and Multimodal Treatment Strategies: A Retrospective Case Series

“…Recognizing considerations unique to the head and neck, and the limitations of tumor size in T-staging, a site-specific staging system was adopted by the AJCC in its eighth edition [ 5 ]. Notably, invasion into local structures (i.e., skull base) is the primary criteria for T4 staging and several studies have demonstrated this to be significantly predictive of poor long-term outcomes for head and neck STS, regardless of tissue of origin [ 6 , 7 ]. Advanced T-staging is considered a driving factor in guidelines regarding resectability and determining (neo)adjuvant treatment strategies.…”