Soft tissue sarcomas of the head and neck. Clinical and pathological evaluation of 108 cases in Mexico

Salcedo-Hernández, Rosa Angélica; Lino-Silva, Leonardo S.; Mosqueda‐Taylor, Adalberto; Luna-Ortiz, Kuauhyama

doi:10.1016/j.jcms.2014.01.033

Cited by 11 publications

(14 citation statements)

References 26 publications

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“…In accordance with previous studies (19)(20)(21), lymph node involvement was 14%, and distant metastasis rate 27%. Prognostic factors for STS of the head and neck include tumor size over 5 cm, histological grade, and resection margin (2,21).…”

Section: Discussionsupporting

confidence: 92%

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Elsayad

Stockmann

Channaoui

et al. 2019

In Vivo

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Background: Image-guided intensity-modulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with soft-tissue sarcoma (STS) of the head and neck. Although there is no comparison between IMRT and conventional radiation therapy (CRT) concerning their efficacy. In this analysis, we compared CRT and IMRT outcomes for head and neck STS. Patients and Methods: Sixty-seven patients who underwent radiotherapy between 1994 and 2017 were identified. Results: The median follow-up was 31 months. Of the 67 patients, 34% were treated with CRT technique and 66% with IG-IMRT. The locoregional relapse rate following IMRT was 21% versus 70% with CRT (p<0.001) and the 5-year locoregional control was 69% versus 28%, respectively (p=0.01). IG-IMRT was associated with non-significant, less acute, and chronic adverse events. In the multivariate analysis, a significant influence of radiation technique on locoregional control was confirmed (p=0.04). Conclusion: IG-IMRT seems to be associated both with higher locoregional control as well as lower acute and chronic toxicities. Head and neck soft-tissue sarcoma (STS) is a rare tumor arising from soft tissue, and represents ~10% of all sarcomas (1, 2). Thus, patient groups presented in such studies are often small and non-homogeneous. STS in the head and neck, specifically, requires special management due to both its location and threat to numerous organs. Prognosis, as well as treatment, of head and neck sarcomas differs from that of other locations, owing to the limited scope for wide local excision due to the presence of important nearby structures and organs. Such localizations bear approximately 10% lower absolute difference in 5-year locoregional control (LRC) and overall survival (OS) as compared to sarcoma of the extremities (1-4). In addition to surgical resection, radiotherapy (RT) represents an important cornerstone of treatment. For instance, the most common RT indications are high tumor grade, large tumor, close resection margins, and locally advanced stage (2, 5). Recently, the TNM classification system has been revised to consider tumor size more heavily for better prognostic stratification (6). The role of adjuvant chemotherapy (CTX) is unclear and depends on many factors, such as histological subtype, grade. Therefore, treatment must be individualized and made on a case-by-case basis (5, 7). Emerging treatments, such as use of checkpoint inhibitors, is currently under investigation as an adjuvant therapy with the hope of reducing risk of relapse (8). Image-guided intensity-modulated radiotherapy (IMRT) aims to deliver a homogeneous dose distribution into the tumor bed with maximum protection or sparing of organs at risk (OAR), with optimal positioning of patients (9). In addition, interfractional imaging may allow further adaptive planning in order to escalate the radiation dose, suggesting an improvement of outcome in comparison with conventional radiotherapy (CRT) (10, 11).

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Section: Discussionsupporting

confidence: 92%

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Elsayad

Stockmann

Channaoui

et al. 2019

In Vivo

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“…Our 66% 5-year overall survival in adult sarcoma cases compares favorably with 44–70% reported in other series ( 3 , 4 , 9 , 23 , 24 , 30 , 36 , 40 – 42 ). Long-term survival is likely with a follow-up of around 4.5 years being the critical landmark.…”

Section: Discussionsupporting

confidence: 82%

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

et al. 2015

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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.

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“…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. A recent study found an estimated 5‐years disease‐specific survival for the study group was 72% and the estimated overall survival was 61%, which is comparable to other studies showing 5‐years disease‐specific survival of 72–83% . Overall 5‐years survival from studies between 1993 and 2016 varies from 44 to 80% .…”

Section: Prognosis and Survival From Head And Neck Stsmentioning

confidence: 50%

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

Tudor-Green

Fonseca

Gomez

et al. 2017

J Oral Pathology Medicine

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Head and neck soft tissue sarcomas are a group of rare heterogeneous tumours arising from embryonic mesoderm. They comprise <1% of all head and neck malignancies and 5-15% of all sarcomas with most head and neck sarcomas arising from soft tissues. Although rare, they are associated with both high recurrence and mortality rates. We review the current management of head and neck soft tissue sarcomas.

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Soft tissue sarcomas of the head and neck. Clinical and pathological evaluation of 108 cases in Mexico

Cited by 11 publications

References 26 publications

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

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

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

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