Sarcomas of the head and neck. Prognostic factors and treatment strategies

Abstract

The authors reviewed 164 cases of head and neck sarcoma from adult patients seen at the University of California, Los Angeles (UCLA), between 1955 and 1988. The median follow‐up was 70 months. Multivariate analysis demonstrated that tumor grade, size, and surgical margin status were the most important independent prognostic factors. Thirty‐one percent (27 of 85) of patients with high‐grade lesions were free of disease versus 81% (44 of 55) with low‐grade lesions at last follow‐up. Sixty‐seven percent (50 of 76) of patients with lesions smaller than 5 cm were free of disease versus; 38% (33 of 88) with lesions larger than 5 cm. In 16 patients, low‐grade lesions, measuring less than 5 cm and with negative margins histologically, were controlled with surgery alone. For the 94 patients whose primary tumors were treated at UCLA, local control was achieved in 52% (26 of 50) of patients treated with surgery alone and 90% (20 of 22) with combined therapy (surgery and radiation therapy [RT] with or without chemotherapy). Seventy‐five percent (6 of 8) of patients with positive surgical margins treated with post‐operative RT achieved local control versus 26% (5 of 19) of patients receiving no additional treatment. In conclusion, surgery alone appears to be adequate treatment for small, low‐grade tumors and negative surgical margins. Patients with incomplete resection or high‐grade tumors should receive aggressive treatment–surgery and RT.

Head and Neck Soft Tissue Sarcoma

“…Due to the anatomical complexity and surrounding vital structures in the head and neck region, wide excision with adequate margin is not possible in all cases. Resection of gross tumor with post-operative adjuvant therapy is the treatment in most cases [27]. Adjuvant post-operative radiation therapy is often utilized if margins are close or the histology of the lesion is high-grade.…”

“…Adjuvant post-operative radiation therapy is often utilized if margins are close or the histology of the lesion is high-grade. Adjuvant brachytherapy has been shown to improve local control after complete resection of highgrade sarcomas [27,28]. Chemotherapy alone has no role in managing HN-STS [29] Surgery Adequate surgical excision is not applicable in most of head and neck sarcomas due to the complex anatomy and close proximity of major vital structures to primary tumor.…”

“…Taking into consideration that neck lymph node metastasis in head and neck sarcomas is about 3%, neck dissection is indicated only in cases where palpable lymph node is identified in the neck or electively in sarcoma at high risk of nodal metastasis [11]. Lymph node metastasis from primary sarcoma in head and neck is more with embryonic rhabdomyosarcoma, epithelioid sarcoma, clear cell sarcoma, synovial cell sarcoma and vascular sarcoma [27]. Regional metastasis of head and neck sarcomas is almost exclusively in high-grade sarcomas [29].…”

“…There is no role for elective neck irradiation prophylactically in head and neck sarcomas, due to the low incidence of positive lymph nodes in the neck, Radiotherapy is indicated as follows in head and neck sarcoma [27] for high grade sarcomas, positive surgical margins, lesions larger than 5 cm and recurrent lesions. The total recommended radiation dose for low-grade sarcomas is 6000 cGYand 6500 cGY for high-grade sarcomas.…”

“…They are rare group of malignancies that constitute less than 1% of body's tumors, including those of the head and neck region [2][3][4][5]. 5-15% of adult sarcomas are in the head and neck region, while 20% of them arise from bones and cartilages and 80% arise in soft tissues [3,[6][7][8][9]. Of soft tissues sarcomas, 80-90% affect adults and 10-20% are seen in children [6].…”