Spindle cell carcinoma of the head and neck region: treatment and outcomes of 15 patients

Abstract

IntroductionSpindle cell carcinoma of the head and neck is a rare entity and the evidence of optimal management is lacking. The objective of our study was to report the treatment and outcomes of 15 patients treated in a single institution over a seven year period.Materials and MethodsA total of 15 patients (12 males and 3 females) with spindle cell carcinoma of the head and neck were treated between July 2007 to June 2014. In six patients the disease developed after previous radiotherapy. Of the 15 patients, five patients had their primary in the tongue, four in the paranasal sinuses, two in the hypopharynx, two in the vocal cords, and one each in the soft palate and the floor of mouth. Eleven patients were treated with radical intent (seven patients required surgery only and four were treated with combined modality). The remaining four patients were treated with palliative intent.ResultsAmong 11 patients treated with radical intent eight are alive or died of non-oncological causes. The disease recurred locally in three patients and they died of the disease (two patients with locally advanced disease in the tongue and one patient with T1N0 tumour in the hypopharynx). Median overall survival (OS) was 18 months.ConclusionSurgery or surgery combined with radiotherapy has a real impact on the natural cause of spindle cell carcinoma of the head and neck region. Even locally advanced tumours can be controlled with aggressive treatment. The worst outcome is seen with the tongue as the primary site because of a high local recurrence rate.

A Report of Spindle Cell Carcinoma in Maxillary Sinus: Diagnosis and Management

“…Either radiotherapy or chemotherapy is an alternative option for inoperable patients or those with sinonasal tumors. Overall, the time of diagnosis and the site of lesion affect the outcome so that early stage diagnosis and extraoral lesion have been resulted in better outcomes (12)(13)(14)). Some studies reported the increased mortality rate in the tumors of the head and neck area as a result of lower resistance to tumor-spreading along tissue planes and extensive lymph drainage system with resultant lymphatic and distant metastases (3,4,13).…”

Second Primary Spindle Cell Carcinoma of Oral Cavity and Oropharynx: A Case Report and Literature Review

“…Multiple studies [4,15,16] suggested that the patients who underwent operation had a more favorable outcome. Some observational studies [4,16] showed a less favorable outcome in patients who received radiotherapy alone compared with the operation group, while the authors of the study admitted that selective bias should be considered, as the patient who was not feasible for surgery probably represented the more advanced disease.…”

“…The rule of adjuvant chemo or radiotherapy still remains unclear. A series with 15 cases [15] was an overview of treatment of SpCC, in which surgery with adjuvant radiotherapy or chemotherapy seemed to reduce the recurrence rate of tumor. As a result, operation as the first line therapy whenever the tumor is resectable, following adjuvant chemo or radiotherapy, may reach a more favorable outcome.…”

“…The patient underwent surgery and adjuvant chemoradiotherapy. Surgery with adjuvant radiotherapy or chemoradiotherapy was suggested in a case series for the treatment of oropharyngeal SpCC [15,16].…”

Two cases of spindle cell carcinoma with a histopathological review of biphasic tumours of head and neck

“…No definite treatment protocol exists for this unique entity and tumour is primarily treated with aggressive, wide local excision. Adjuvant radiation and/or chemotherapy should be used in case of incomplete removal or positive surgical margins [12]. While other studies suggest that postoperative chemoradiation therapy improves patient prognosis and should be considered as the standard therapeutic modality [13].…”