Excellent local control and survival after postoperative or definitive radiation therapy for sarcomas of the head and neck

Abstract

BackgroundTo report our results with postoperative or definitive radiation therapy in head and neck sarcomas.MethodsWe performed a retrospective analysis of 26 patients suffering from head and neck sarcomas, who received postoperative or definitive radiation therapy between 2003 and 2012. Median age was 64 years (19–88) and 69 % were male. Tumor locations were skull (including skin) in 31 %, paranasal sinus/orbita in 27 % and neck (including pharynx/larynx) in 42 %. Median tumor size was 4.6 cm (1-12 cm). 22 patients (85 %) presented in primary situation. Stage at presentation (UICC 7th for soft tissue sarcomas) was as follows: Ia:4 %, IIa:50 %, IIb:15 %, III:31 %. All except one patient suffered from high grade lesions (G2/3 FNCLCC), predominantly angiosarcoma (35 %), MFH (19 %) and synovial sarcoma (15 %). Surgery was performed in 21 pts (81 %), resulting in free margins in 10 (38 %), microscopically positive margins in 6 (23 %) and gross residual disease in 5 (19 %). Median dose to the primary tumor region was 66Gy (45-72Gy) in conventional fractionation, using 3D-CRT in 65 %, IMRT in 27 % and electrons in 8 %. 50 % of the patients also received sequential chemotherapy.ResultsMedian follow up was 39 months (8–136). We observed three local recurrences, transferring into estimated 3- and 5-year local control rates of 86 %. One additional patient failed distantly, resulting in 3- and 5-year freedom from treatment failure rates of 82 %. Four patients have deceased, transferring into 3- and 5-year overall survival rates of 88 % and 82 %, respectively. Only two of the four deaths were sarcoma related. Maximum acute toxicity (CTCAE 3.0) was grade 1 in 27 % of the patients, grade 2 in 50 % and grade 3 in 23 %. Severe acute toxicity was mainly represented by mucositis and dysphagia. Maximum late toxicity was grade 1 in 31 %, grade 2 in 15 % and grade 3 in 19 % of the patients. Severe late toxicity included skin ulceration (n = 1), dysphagia with persistent tube dependency (n = 1), persistent sinusitis (n = 1) and hearing loss (n = 2).ConclusionExcellent local control and overall survival rates can be achieved with postoperative or definitive radiation therapy with acceptable acute and late toxicities in patients suffering from sarcomas of the head and neck region.

Liposarcoma of the Thyroid: A Case Report with a Review of the Literature

“…In sarcomas, the improvement in locoregional control and overall survival achieved by the addition of radiation has shown to be related to tumor grade and the narrowness of the surgical margins [27]. As extensive surgical margins are often difficult to accomplish in the neck region, it has been shown that postoperative radiation may improve local control rates [28]. Chemotherapy was included in 23.08% of the cases, as recommended for patients previously treated by surgery and/or radiation with metastatic or recurrent disease.…”

UK guidelines for the management of soft tissue sarcomas

“…In these cases, radiotherapy can occasionally provide a durable remission although local recurrence rates are high. Outcomes appear related to tumour size, grade, and radiation dose [56–59]; doses of over 60 Gy may be employed. In patients with significant life-limiting comorbidities lower dose, palliative radiotherapy is an option.…”

Malignant peripheral nerve sheath tumor of nasal cavity and paranasal sinus with 13 years of follow‐up—A case report and review of literature

“…Radiation treatment confers an improvement in local control, but not overall survival . However, excellent survival rates have been reported after definitive or postoperative radiation treatment for sarcoma of the head and neck region …”