Radiotherapy for Adult Soft Tissue Sarcomas of the Head and Neck

Abstract

Objective: Surgery followed by postoperative radiation therapy (RT) is the standard of care for soft tissue sarcomas (STS) of the head and neck that are high grade or have close or positive margins. Methods: The authors retrospectively reviewed adult patients with head and neck STS treated with RT at a single institution between 1981 and 2017. All patients who were 19 years and older with STS of the head and neck—excluding rhabdomyosarcoma, angiosarcoma, and Ewing tumors—were included in this study. Toxicity was graded using Common Terminology Criteria for Adverse Events (CTCAE), version 4. Results: Among 34 patients with head and neck STS treated with postoperative RT (33) or primary RT (1) who met the inclusion criteria, the median age at diagnosis was 45 years (range, 20 to 83). Overall, 37% had T1 tumors, 50% had high-grade histology (grade 3), and 26% had microscopically positive margins. The median RT dose was 65 Gy to the primary site; 29% received elective nodal irradiation. The median follow-up for living patients was 16.6 years (range, 0.6 to 30). At 5 and 10 years, the local control rates were 88% and 80%, the regional control rates were 97% and 97%, the freedom from distant metastases rates were 100% and 100%, the cause-specific survival rates were 88% and 81%, and the overall survival rates were 85% and 69%. Two patients (6%) developed late grade 3+ complications. Conclusion: Our study demonstrates that surgery and radiotherapy for STS of the head and neck have excellent disease outcomes.

Angiosarcomas of the head and neck: Impact of large data analysis on clinical management

“…The application of radiation therapy is guided by well-defined but illsupported criteria, including the presence of unsatisfactory surgical margins and/or the presence of high grade or large tumor size. 22 In general, postoperative radiation therapy results in an approximately 85% 5-year local control compared to an approximately 50% local control in cases where surgery was applied alone. In the setting of positive surgical margins, this difference in local control was found to be larger.…”

“…In general, postoperative radiation therapy results in an approximately 85% 5‐year local control compared to an approximately 50% local control in cases where surgery was applied alone. In the setting of positive surgical margins, this difference in local control was found to be larger 22 . Nonetheless, it is important to realize that most data are based upon retrospective studies, and significant levels of bias and confounding are to be expected when comparing radiated and nonradiated groups of patients retrospectively.…”

“…Nonetheless, it is important to realize that most data are based upon retrospective studies, and significant levels of bias and confounding are to be expected when comparing radiated and nonradiated groups of patients retrospectively. Most studies suggest that survival is not changed significantly by radiation therapy 22 . This is understandable as the high rate of distant metastasis which typifies sarcomas remains unaffected by radiation therapy.…”

“…In the setting of positive surgical margins, this difference in local control was found to be larger. 22 Nonetheless, it is important to realize that most data are based upon retrospective studies, and significant levels of bias and confounding are to be expected when comparing radiated and nonradiated groups of patients retrospectively. Most studies suggest that survival is not changed significantly by radiation therapy.…”

“…Most studies suggest that survival is not changed significantly by radiation therapy. 22 This is understandable as the high rate of distant metastasis which typifies sarcomas remains unaffected by radiation therapy. The experience with chemotherapy application in soft tissue sarcomas has generally been quite disappointing unfortunately.…”