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Cattan MES, Kimura TDC, Lavareze L, Egal ESA, Altemani A, Mariano FV. Head and neck sarcomas: Thirty years of experience in a tertiary referral center in Brazil. Head Neck 2024. [PMID: 39323102 DOI: 10.1002/hed.27933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/28/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
PURPOSE This study analyzed the demographics, clinicopathological, treatment, and survival characteristics of head and neck sarcomas (HNS) diagnosed in a tertiary reference center in Brazil. MATERIALS AND METHODS HNS cases were retrospectively retrieved from the Department of Pathological Anatomy of the School of Medical Sciences of the State University of Campinas. The medical records were examined to extract demographic, clinicopathological, and follow-up information. The Pearson chi-square test, Kaplan-Meier curve, and Cox proportional hazards regression model were employed to identify survival and potential prognostic factors. RESULTS A total of 47 patients were included in the study. The majority were men (61.7%) with a mean age of 38.9 years. The nasal cavity (34.0%) was the most common anatomical site. The lesions are usually presented as volume increases (78.7%). The most common histological subtypes were chondrosarcoma, osteosarcoma, and alveolar rhabdomyosarcoma. Surgical excision alone was the most common treatment modality. Local recurrence was observed in 10 cases, and metastases in 3 cases. During a mean follow-up period of 71.9 months, from diagnosis to the last follow-up, 31 patients (65.9%) were alive without the disease. A total of 10 patients (21.3%) died of the HNS for a mean follow-up period of 14.3 months. The time to presentation of more than 6 months (p = 0.0309) and the presence of metastases (p = 0.0315) were identified as prognostic factors for survival, while male sex was found to be an independent prognostic factor for recurrence. CONCLUSION In conclusion, the results of this study indicate that the occurrence of a shorter lesion time to presentation and the presence of metastases were associated with a reduction in survival rates in patients with HNS.
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Affiliation(s)
- Marcelo Elias Schempf Cattan
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Talita de Carvalho Kimura
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, Brazil
| | - Luccas Lavareze
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, Brazil
| | - Erika Said Abu Egal
- Biorepository and Molecular Pathology, Huntsman Cancer Institute, University of Utah (UU), Salt Lake City, Utah, USA
| | - Albina Altemani
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda Viviane Mariano
- Department of Pathology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, Brazil
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Mannelli G, Bassani S, Cosi G, Fermi M, Gazzini L, Liberale C, Mazzetti L, Parrinello G, Saibene AM, Molteni G, Comini LV. Global frequency and distribution of head and neck sarcomas in adulthood: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:2553-2567. [PMID: 38381151 DOI: 10.1007/s00405-024-08477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Head and neck sarcomas (HNS) constitute a rare and heterogeneous cancer entity. Management remains a challenge due their rarity and different biological behaviour among tens of subtypes. This systematic review aimed to describe HNS global frequency and distribution in adulthood. METHODS A systematic review was performed using PICOTS search strategies for qualitative question and it was written in accordance with PRISMA 2020 Statement. 70,653 publications were identified, and 15 variables were evaluated for a total of 2428 patients. RESULTS We identified 47 studies from 21 different countries from 5 different continents. Most of studies (83.3%) were performed in single institutions and America and Asia overruled for number of papers included (21 and 10, respectivelly). Osteosarcoma was more frequent, followed by chondrosarcoma, angiosarcoma and malignant fibrous histiocytoma. Early stage accounted for almost 80% of cases; advanced stage prevailed in developing countries. 1783 patients (90.1%) underwent surgery and 780 (39.4%) had adjuvant therapy. 50.8% of patients experienced tumour recurrence and the lowest mortality rate was reported in Europe (29.9%). CONCLUSIONS HNS holds a relative poor prognosis possibly explained by the heterogeneity of the disease. Treatment of HNS has shown to be highly diverse among different countries, underlining the importance of uniformed treatment guidelines to achieve better patient management and to improve survival outcomes.
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Affiliation(s)
- Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Bassani
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Ginevra Cosi
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Fermi
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Carlotta Liberale
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Luca Mazzetti
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giampiero Parrinello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Martino Polyclinc Hospital, Genoa, Italy
| | - Alberto Maria Saibene
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology Department, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università Degli Studi di Milano, Milan, Italy
| | - Gabriele Molteni
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Lara Valentina Comini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria.
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale, 142-KM 3.95, 10060, Candiolo, TO, Italy.
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Rikitake R, Mizushima Y, Yoshimoto S, Higashi T, Satake T, Morizane C, Kawai A. Current status of head and neck sarcomas in Japan in 2016-2019: an analysis using the national cancer registry. Int J Clin Oncol 2024; 29:564-570. [PMID: 38411881 PMCID: PMC11043187 DOI: 10.1007/s10147-024-02484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Head and neck sarcomas are especially rare in Asia, leading to limited clinical evidence. This study aimed to investigate the incidence, clinical features, treatment status, and outcome of these sarcomas using data from the National Cancer Registry in Japan. METHODS All head and neck sarcomas diagnosed between 2016 and 2019 and recorded in the National Cancer Registry were analyzed. Data on sex, age, primary site, histological type, stage, treatment modality, and prognostic information were collected. Age-adjusted incidence and 3-year survival rates of patients with head and neck sarcomas were calculated. RESULTS Overall, 635 head and neck sarcoma patients were identified. Head and neck sarcoma occurred more frequently in men and patients in their 70 s. The age-adjusted annual incidence rate was 0.125 per 100,000 patients in the 2015 Japanese model or 0.089 per 100,000 patients in the world population model. The nasal cavity and paranasal sinuses were the most frequent primary sites, with rhabdomyosarcoma as the most common histologic type. Treatment typically involved chemotherapy and/or radiation therapy for rhabdomyosarcoma and Ewing's sarcoma, whereas surgical approaches for other types. Three-year survival rate of head and neck sarcoma patients was 64.8%. CONCLUSIONS Head and neck sarcomas occurred rarely, but most frequently in the nasal cavity and paranasal sinuses in Japan. Poor outcomes were observed for sarcoma patients than for non-sarcoma head and neck cancer patients.
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Affiliation(s)
- Ryoko Rikitake
- Department of Public Health and Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
- Institute for Cancer Control, Division of Health Services Research, National Cancer Center, Tokyo, Japan.
- Rare Cancer Center, National Cancer Center, Tokyo, Japan.
| | - Yu Mizushima
- Institute for Cancer Control, Division of Health Services Research, National Cancer Center, Tokyo, Japan
| | - Seiichi Yoshimoto
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Higashi
- Department of Public Health and Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Institute for Cancer Control, Division of Health Services Research, National Cancer Center, Tokyo, Japan
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Tomoyuki Satake
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chigusa Morizane
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
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Saghravanian N, Rahpeyma A, Ghorbani M, Saeedi P. Synovial sarcoma of the maxilla: A challenging diagnostic case report and literature review. Clin Case Rep 2023; 11:e8254. [PMID: 38028103 PMCID: PMC10675101 DOI: 10.1002/ccr3.8254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
Synovial sarcoma, a malignant mesenchymal tumor, is primarily associated with the extremities. Nevertheless, its appearance within the head and neck region, particularly in the maxillary area, is remarkably rare. This rarity underscores the significance of each case in unraveling the complexities of its behavior and management strategies. The core focus of this research is a detailed case report involving a 6-year-old female patient who presented with a conspicuous swelling in the left posterior maxilla. Subsequent incisional biopsy led to microscopic identification of malignant spindle cell proliferation, marked by dysplastic changes, and abundant mitoses. Immunohistochemical (IHC) analysis demonstrated negative reactivity for neural and muscular markers, while positive expression of Vimentin, Bcl-2, and TLE1. These morphological and IHC findings coalesced to definitively diagnose synovial sarcoma, substantiated by a notable 40% Ki67 proliferative index. The chosen treatment strategy encompassed surgery and radiotherapy, which yielded successful outcomes, with no recurrence observed during the one-year follow-up period. Beyond the specific case, this article undertakes a review of existing literature, meticulously analyzing nine similar cases reported in scholarly sources.
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Affiliation(s)
- Nasrollah Saghravanian
- Oral and Maxillofacial Disease Research Center, School of DentistryMashhad University of Medical SciencesMashhadIran
| | - Amin Rahpeyma
- Oral and Maxillofacial Disease Research Center, School of DentistryMashhad University of Medical SciencesMashhadIran
| | - Mahsa Ghorbani
- School of DentistryMashhad University of Medical SciencesMashhadIran
| | - Pooya Saeedi
- School of DentistryMashhad University of Medical SciencesMashhadIran
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Jiang K, Cai SH, Ou BY, Du DF, Guan YX, Chen SW, Liang Y. Time to Local Recurrence as a Predictor of Survival in Adult Head and Neck Soft Tissue Sarcoma. Laryngoscope 2023; 133:2174-2182. [PMID: 36286082 DOI: 10.1002/lary.30463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to evaluate the impact of the time interval from surgical resection to local recurrence (TTLR) on clinical outcomes in head and neck soft tissue sarcoma (HNSTS). METHODS A total of 401 patients who underwent R0 resection for primary HNSTS were included in this study. Patients with local recurrence as the first event after their initial resection were divided into early local recurrence (ELR) or late local recurrence (LLR) groups according to TTLR. Multiple survival analyses were performed to identify the independent prognostic predictors of overall survival (OS) and survival after local recurrence (SAR). RESULTS Two hundred and nine of the 401 patients (52.1%) developed local recurrence during a median follow-up period of 134.6 months. Patients in the ELR group had a shorter median OS time (35.0 vs. 120.6, p < 0.001) and lower 5-year OS rate (47.7% vs. 80.9%, p < 0.001) than those in the LLR group. Moreover, the ELR group exhibited worse SAR (p = 0.001) than the LLR group, and multivariate analyses demonstrated TTLR as an independent prognostic factor for SAR (p = 0.048) and OS (p = 0.004). Additionally, re-resection significantly prolonged SAR than other salvage interventions or no treatment (p < 0.001). CONCLUSION In patients with HNSTS, ELR after R0 resection presents adverse effects on OS and SAR than those with LLR, and TTLR could serve as a promising predictor for survival. Salvage therapies, especially the re-resection could improve SAR and should be recommended when there are surgical indications after recurrence. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2174-2182, 2023.
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Affiliation(s)
- Ke Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shao-Hui Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bi-Yi Ou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ding-Fu Du
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuan-Xiang Guan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shu-Wei Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yao Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Bandiera G, Covelli E, Elfarargy HH, Rogges E, Barbara M, Sabino L, Filippi C. Long-term follow-up after surgical management of laryngeal malignant pleomorphic sarcoma ‒ a case report. Braz J Otorhinolaryngol 2023; 89:101276. [PMID: 37315424 PMCID: PMC10391340 DOI: 10.1016/j.bjorl.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Giorgio Bandiera
- Sapienza University, Sant' Andrea University Hospital, Mental Health, and Sense Organs (NEMOS), Department of Neuroscience, Rome, Italy
| | - Edoardo Covelli
- Sapienza University, Sant' Andrea University Hospital, Mental Health, and Sense Organs (NEMOS), Department of Neuroscience, Rome, Italy.
| | - Haitham H Elfarargy
- Sapienza University, Sant' Andrea University Hospital, Mental Health, and Sense Organs (NEMOS), Department of Neuroscience, Rome, Italy; Kafrelsheikh University, Otorhinolaryngology Department, Kafrelsheikh, Egypt
| | - Evelina Rogges
- Sapienza University, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Rome, Italy
| | - Maurizio Barbara
- Sapienza University, Sant' Andrea University Hospital, Mental Health, and Sense Organs (NEMOS), Department of Neuroscience, Rome, Italy
| | - Luigi Sabino
- Sapienza University, Sant' Andrea University Hospital, Mental Health, and Sense Organs (NEMOS), Department of Neuroscience, Rome, Italy
| | - Chiara Filippi
- Sapienza University, Sant' Andrea University Hospital, Mental Health, and Sense Organs (NEMOS), Department of Neuroscience, Rome, Italy
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Roos JH, Mäkitie AA, Tarkkanen J, Ilmarinen TT. Pretreatment tumor sampling and prognostic factors in patients with soft-tissue sarcoma of the head and neck. Eur Arch Otorhinolaryngol 2021; 279:3147-3155. [PMID: 34773167 PMCID: PMC9072459 DOI: 10.1007/s00405-021-07162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Insufficient preoperative work-up and consequent intralesional or marginal resection of soft-tissue sarcomas of the head and neck (STSHNs) is common. METHODS This retrospective cohort study comprised 63 patients with STSHN treated at the Helsinki University Hospital between 2005 and 2017. We assessed the effect of pretreatment tumor sampling on surgical margin status and need for supplemental surgery, as well as prognostic factors and survival. RESULTS The lack of representative pretreatment biopsy specimen was associated with unfavorable margin status. Primary surgery at a non-academic center was associated with need for supplemental surgery. The 3-year overall survival (OS) was 68%, disease-specific survival (DSS) 71%, and recurrence-free survival (RFS) 61%. Higher tumor grade and primary tumor size over 5 cm were associated with reduced DSS. CONCLUSIONS Diagnosis and management of STSHNs should be centralized to experienced academic centers. Decision-making between needle biopsy, open biopsy, or upfront radical surgery depends on tumor location and size.
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Affiliation(s)
- Johan H Roos
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.
| | - Antti A Mäkitie
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taru T Ilmarinen
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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8
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Patra S, Trivedi P, Shah A. Primary Sarcoma of the Head and Neck: Three Years’ Experience in a Tertiary Care Cancer Center. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1728219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Sarcomas are a heterogeneous group of malignancies originating from the transformed cells of mesenchymal lineage, representing only 1% of all the primary tumors arising within the head and neck region with a prevalence range of 4 to 10%. They are biologically different from the sarcomas of other sites because of the smaller size of the tumor at the time of presentation and higher chances of local recurrences. Due to the rarity in adults, there are very few studies on sarcomas of the head and neck. The aim of this study was to analyze the frequency and spectrum of primary sarcomas in the head and neck region.
Materials and Methods This is a retrospective descriptive study. The authors analyzed 40 cases of histologically and immunohistochemically proven primary sarcomas arising in the head and neck region according to three age groups, pediatric (<12 years), adolescent (12–19 years), and adults (> 19 years).
Results Primary sarcomas represented 0.06% and 2.4% of total cancer cases and total sarcoma cases, respectively. Embryonal rhabdomyosarcoma was the most common histologic type, and nasopharynx the most common location in the pediatric population. Osteoblastic osteosarcomas and Ewing’s sarcoma were typical variants in adolescent age, affecting the hemimandible predominantly. In adults, osteosarcomas were commonest followed by conventional grade 1 chondrosarcoma. Treatment was planned according to the stage and grade of the tumor. Out of the 40 patients, 19 (47.5%) had a disease relapse within a period of 6 months from the completion of therapy.
Conclusion Head and neck sarcomas are notorious to recur. A timely and accurate diagnosis, proper staging, and multidisciplinary treatment plan can yield good patient outcomes.
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Affiliation(s)
- Sanjiban Patra
- Department of Oncopathology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Oncopathology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Anand Shah
- Department of Community Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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How Can a Multidisciplinary Approach Improve Prognosis of Soft-Tissue Sarcomas of Extremities? Int J Surg Oncol 2021; 2021:8871557. [PMID: 33833875 PMCID: PMC8012127 DOI: 10.1155/2021/8871557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/21/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Soft-tissue sarcomas are malignant tumors that require good management within specialized centers. Our study aims to assess the benefit of handling these kinds of tumors using the Multidisciplinary Meeting (MDM) approach. The current paper details this approach through a prospective study that has lasted for 42 months in the HASSAN II University Hospital Center, Fez, Morocco. During this research work, 116 cases were selected with an average age of 53 years. In 95.7% of the cases, it was found that the lower limb was the most frequent tumor type (78.4%). Also, ninety-two (92) patients (79.3%) have had a prior biopsy. Ninety-nine (99) patients (85.3%) have received a magnetic resonance imaging scan (MRI) before surgery. Sixty-three (63) patients were operated on, including R0 resection used for 37 patients, R1 used for 21 patients, and R2 used for five patients. As a result, liposarcomas were the most frequent type (30.1%), followed by synovial sarcomas (14.6%), leiomyosarcomas (9.5%), ewing sarcoma (8.6), and undifferentiated pleomorphic sarcomas (7.7%). In addition, neoadjuvant chemotherapy was used for 36 patients. The other 22 patients received adjuvant chemotherapy and/or radiotherapy. The overall survival rate was 60.56 months, which proves a significant improvement, thanks to the multidisciplinary meeting approach. Conclusion. The conducted investigation has shown that using MDM for managing soft-tissue sarcomas of extremities improves the patients' survival rate. Moreover, results have proven MDM might allow optimal treatment regarding less local recurrence and metastasis.
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Yanzon A, Gomez NL, Picco P, Boccalatte L, Cayol F, Larrañaga J, Figari M. Head and neck sarcomas: treatment outcomes in a tertiary referral center in Argentina. Oral Maxillofac Surg 2021; 25:509-518. [PMID: 33587234 DOI: 10.1007/s10006-021-00944-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the clinical findings, management, and results of oncological treatments and to identify prognostic factors in patients diagnosed with head and neck sarcoma. METHODS We performed a retrospective analysis including 48 adult patients with primary head and neck sarcomas, treated between 2006 and 2018 in a referral center of Argentina. RESULTS The median follow-up time was 44 months (range: 4-146 months). Five-year overall survival was 68%. On univariate analysis, radiation-induced sarcomas (p=0.038) had worse survival. Five-year disease-free survival was 58% and local recurrence at 2 years was 22.7%. On multivariate analysis, positive/close resection margins (p=0.031), radiation-induced sarcomas (p=0.037), and mandibular and oral cavity location (p=0.002) were independent prognostic factors associated to local recurrence and shorter disease-free survival. CONCLUSION Head and neck sarcomas are a rare entity. Surgery is feasible in more than 80% of patients, with an acceptable overall and disease-free survival. Radiation-induced sarcomas, location in the mandible and oral cavity, and close margins were significant prognostic factors in our population.
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Affiliation(s)
- Alejandro Yanzon
- Head and Neck Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH), Buenos Aires, Argentina.
| | - Natalia Lucia Gomez
- Head and Neck Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH), Buenos Aires, Argentina
| | - Pedro Picco
- Head and Neck Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH), Buenos Aires, Argentina
| | - Luis Boccalatte
- Head and Neck Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH), Buenos Aires, Argentina
| | - Federico Cayol
- Oncology Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Larrañaga
- Head and Neck Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH), Buenos Aires, Argentina
| | - Marcelo Figari
- Head and Neck Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH), Buenos Aires, Argentina
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Sa HS, Rubin ML, Ning J, Li W, Tetzlaff MT, McGovern SL, Paulino AC, Herzog CE, Gill JB, Esmaeli B. Association of T and N Categories of the American Joint Commission on Cancer, 8th Edition, With Metastasis and Survival in Patients With Orbital Sarcoma. JAMA Ophthalmol 2020; 138:374-381. [PMID: 32105303 DOI: 10.1001/jamaophthalmol.2020.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance No previous studies to date have validated the American Joint Committee on Cancer (AJCC) 8th edition of the TNM classification for orbital sarcoma. Objectives To determine the prognostic performance of the most recent TNM classification for orbital sarcoma and to identify other prognostic factors for local recurrence, lymph node metastasis, distant metastasis, and death due to disease. Design, Setting, and Participants This single-center retrospective cohort study included 73 consecutive patients treated for orbital sarcoma from March 1, 2003, through June 30, 2018. Data were analyzed from November 1 to December 31, 2018. Main Outcomes and Measures T and N categories at presentation and disease-related outcomes, including local recurrence, lymph node metastasis, distant metastasis (DM), and death due to disease (DD). Results The 73 participants included 43 men (59%), and the median age was 21 (range, 0-77) years. The common histologic types were rhabdomyosarcoma (RMS) (35 [48%]), solitary fibrous tumor/hemangiopericytoma (10 [14%]), and Ewing sarcoma (8 [11%]). The most common TNM designations were T2 N0 M0 (26 [36%]) and T4 N0 M0 (24 [33%]). T category was associated with the risk of all disease-related outcomes, including local recurrence (hazard ratio [HR] for T2 vs T4, 0.22 [95% CI, 0.06-0.81]; HR for T3 vs T4, 0.59 [95% CI, 0.13-2.65]; P = .03), lymph node metastasis by the last follow-up (T1, 1 [14%]; T2, 0; T3, 0; T4, 12 [35%]; P = .001), DM (HR for T2 vs T4, 0.29 [95% CI, 0.08-1.07]; P = .04), and DD (HR of T2 vs T4, 0.16 [95% CI, 0.04-0.73]; HR of T3 vs T4, 0.30 [95% CI, 0.04-2.34]; P = .02). Higher risk of DM and higher risk of DD were associated with disease category of at least T3 (HR for DM, 3.24 [95% CI, 0.89-11.72; P = .06]; HR for DD, 6.32 [95% CI, 1.43-27.95; P = .005]), N1 disease (HR for DM, 13.33 [95% CI, 4.07-43.65; P < .001]; HR for DD, 7.07 [95% CI, 2.45-20.44; P < .001]), tumor size larger than 3 cm (HR for DM, 2.72 [95% CI, 0.92-8.05; P = .06]; HR for DD, 5.79 [95% CI, 1.85-18.14; P < .001]), and age of patient with RMS younger than 1 year or 10 years or older (HR for DM, 6.85 [95% CI, 0.83-56.53; P = .04]; HR for DD, 7.03 [95% CI, 0.85-57.83; P = .04]). Higher risk of local recurrence was associated with disease category of at least T3 (HR for<T3 vs≥T3, 0.20 [95% CI, 0.06-0.71]; P < .01) and tumor size greater than 3 cm (HR for ≤3 cm vs >3 cm, 0.27 [95% CI, 0.09-0.77]; P = .009). Higher risk of lymph node metastasis was associated with disease category of at least T3 (odds ratio [OR], 13.33 [95% CI, 1.77-602.30]; P = .004), alveolar RMS (OR, 9.98 [95% CI, 2.13-51.55]; P = .001), and age of patient with RMS younger than 1 year or 10 years or older (OR, 9.20 [95% CI, 1.01-458.29] P = .03). Conclusions and Relevance In patients with orbital sarcoma, T and N categories at presentation (defined by the AJCC 8th edition classification) correlate with metastasis and survival. These findings appear to support consideration of strict surveillance testing for regional nodal and systemic metastases in patients with orbital sarcoma with disease category of at least T3 and/or N1 disease.
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Affiliation(s)
- Ho-Seok Sa
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Maria Laura Rubin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Cynthia E Herzog
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
| | - Jonathan B Gill
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
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Radiation Therapy in Adult Soft Tissue Sarcoma-Current Knowledge and Future Directions: A Review and Expert Opinion. Cancers (Basel) 2020; 12:cancers12113242. [PMID: 33153100 PMCID: PMC7693687 DOI: 10.3390/cancers12113242] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment and is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS. Abstract Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.
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Kalavrezos N, Sinha D. Head and neck sarcomas in adulthood: current trends and evolving management concepts. Br J Oral Maxillofac Surg 2020; 58:890-897. [DOI: 10.1016/j.bjoms.2020.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
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Rastatter JC, Sinard RN, Dilger A, Reichek J, Walterhouse DO, Patel U. Survival of Patients With Non-Rhabdomyosarcoma Soft Tissue Sarcomas of the Head and Neck. Laryngoscope 2020; 131:E500-E508. [PMID: 32531087 DOI: 10.1002/lary.28789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate factors associated with overall survival (OS) of patients with non-rhabdomyosarcoma soft tissue sarcomas of the head and neck. STUDY DESIGN Retrospective cohort study. METHODS The National Cancer Database was queried for cases of non-rhabdomyosarcoma soft tissue sarcomas of the head and neck between 2004 and 2014. Cases were categorized according to the World Health Organization classification of soft tissue tumors. A multivariable Cox proportional hazards model was used to evaluate associations with OS. RESULTS A total of 4,555 patients (63.6% male, 36.4% female, mean age 59.6 years) met inclusion criteria. The majority of tumors were classified as miscellaneous (35.9%), followed by vascular (20.1%), smooth muscle (13.5%), fibroblastic/myofibroblastic (12.1%), peripheral nerve (8.5%), adipocytic (7.4%), and undifferentiated (2.5%) sarcomas. The mean follow-up was 37.9 months, and overall mortality (MR) was 45.3%. The best prognosis was seen with fibroblastic/myofibroblastic sarcomas (MR = 20.6%, P < .001), whereas vascular sarcomas had the worst prognosis (MR = 67.6%, P < .001). Resection with clear margins had better OS than microscopically positive margins (hazard ratio [HR] = 1.43, P < .001) or grossly positive margins (HR = 2.97, P < .001). Radiation therapy was associated with better OS than no radiation (HR = 0.86, P = .001). CONCLUSION Non-rhabdomyosarcoma soft tissue sarcomas of the head and neck are associated with significant mortality. OS differs based on histologic subcategorization. Resection of the primary tumor with clear margins demonstrates improved OS for all histologies, suggesting this modality remains the preferred primary treatment when feasible. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E500-E508, 2021.
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Affiliation(s)
- Jeffrey C Rastatter
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Rebecca N Sinard
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Amanda Dilger
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jennifer Reichek
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - David O Walterhouse
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Urjeet Patel
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
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15
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Prognostic significance of positive surgical margins for scalp angiosarcoma. J Formos Med Assoc 2020; 120:217-225. [PMID: 32446755 DOI: 10.1016/j.jfma.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Scalp angiosarcomas (AS) are aggressive soft tissue sarcomas that present with outcomes different from other AS of the head and neck region. Due to the rarity of the disease, limited data on the clinical outcome of scalp AS are available. In particular, the prognostic significance of surgical margins remains controversial and the impact of margin status on survival has not been documented. METHODS We retrospectively reviewed 41 scalp AS patients, including 30 patients with localized disease and 11 patients with initial distant metastasis, treated in our institution between 1997 and 2017. Survival was determined by Kaplan-Meier analysis. In the 30 patients without distant metastasis (localized disease), univariate and multivariate analysis using the Cox proportional hazards model were used to determine clinicopathologic characteristics associated with recurrence free survival (RFS), locoregional control (LRC), and overall survival (OS). RESULTS Totally 41 patients diagnosed with scalp AS were identified, including 30 patients with localized disease and 11 patients with initial distant metastasis on diagnosis. Overall, the median follow-up period was 19.3 (range 0.3-128.5) months. The median survival time was 16.6 (range 0.3-144.3) months and the 5-year OS (95% Confidence Interval (CI)) rate was 22% (12%-42%). In the 30 patients with localized disease, univariate analysis showed that positive margins, either lateral-side or deep-side, were significant prognostic factors for RFS, LRC, and OS (p < 0.05). On multivariate analysis, positive margins emerged as adverse prognostic factors for RFS (Hazard Ratio (HR) 4.29, 95% CI, 1.71-10.75, p = 0.002), LRC (HR 6.35, 95% CI, 2.19-18.37, p = 0.001), and OS (HR 4.73, 95% CI, 1.71-13.07, p = 0.003). CONCLUSION Scalp AS is associated with high local recurrence rates and poor survival outcomes. Positive surgical margins are adverse prognostic factors for survival.
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Évaluation et impact du respect du référentiel ESMO sur la prise en charge des lésions des tissus mous, étude menée au centre de référence de Lorraine. ANN CHIR PLAST ESTH 2019; 64:326-333. [DOI: 10.1016/j.anplas.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022]
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17
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Kim JK, Verma N, McBride S, Riaz N, Boyle JO, Spielsinger D, Sabol C, Waldenberg T, Brinkman T, Alektiar K, Lee NY, Tsai CJ. Patterns of Radiotherapy Use and Outcomes in Head and Neck Soft-Tissue Sarcoma in a National Cohort. Laryngoscope 2019; 130:120-127. [PMID: 30892716 DOI: 10.1002/lary.27901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/02/2019] [Accepted: 02/12/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS We used the National Cancer Database to identify the patterns of care and prognostic factors in adult patients with head and neck soft-tissue sarcoma (HNSTS). STUDY DESIGN Retrospective cohort analysis. METHODS Using the National Cancer Database, we identified patients age ≥ 18 years who were diagnosed with HNSTS between 2004 and 2013. Both χ2 and multivariate logistic regression were used to identify factors associated with radiation therapy (RT) utilization. Kaplan-Meier methods were used to estimate overall survival (OS) and Cox proportional regression was used to determine significant contributors to OS. RESULTS Our final cohort included 1,282 patients (682 treated with surgery only, 199 treated with RT only, and 401 treated with surgery and RT). Patients with younger age, poor tumor grade, rhabdomyosarcoma histology, and chemotherapy treatment were more likely to receive RT alone without surgery. Among the 1,083 surgical patients, RT utilization was associated with positive margins (odds ratio [OR]: 2.18, 95% confidence interval [CI]: 1.36-3.48), poor grade (OR: 2.92, 95% CI: 1.95-4.38), and chemotherapy use (OR: 1.78, 95% CI: 1.15-2.76). Radiotherapy utilization among surgical patients was not affected by demographic factors (age, sex, or ethnicity) or treatment institution (academic or community). For surgical patients, poor grade, large tumor size, and rhabdomyosarcoma histology were associated with worse OS on multivariate analysis. CONCLUSIONS In this analysis of HNSTS, younger patients with poor tumor grade and rhabdomyosarcoma histology were more likely to receive RT without surgery. Among surgical patients, adjuvant RT was more likely to be used for positive margins and poor grade, with no demographic disparities identified. Poor grade and rhabdomyosarcoma histology were negative prognostic factors for surgical patients. LEVEL OF EVIDENCE NA Laryngoscope, 130:120-127, 2020.
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Affiliation(s)
- Joseph K Kim
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Nipun Verma
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Jay O Boyle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Daniel Spielsinger
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Christopher Sabol
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Todd Waldenberg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Thomas Brinkman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Kaled Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
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Tudor-Green B, Gomez R, Brennan PA. Current update on the diagnosis and management of head and neck soft tissue sarcomas. J Oral Pathol Med 2017; 46:674-679. [PMID: 28140483 DOI: 10.1111/jop.12555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 01/19/2023]
Abstract
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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Affiliation(s)
- Ben Tudor-Green
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital, Exeter, UK.,Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Ricardo Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Peter A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Mahmoud O, Beck R, Kalyoussef E, Chan Park R, Baredes S, Kim S, Samuels MA. Adjuvant therapies utilization pattern and survival outcomes in high-grade head and neck soft tissue sarcoma; a population based study. Oral Oncol 2017; 66:28-37. [DOI: 10.1016/j.oraloncology.2016.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 11/16/2022]
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20
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Breakey R, Crowley T, Anderson I, Milner R, Ragbir M. The surgical management of head and neck sarcoma: The Newcastle experience. J Plast Reconstr Aesthet Surg 2017; 70:78-84. [DOI: 10.1016/j.bjps.2016.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/09/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
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Vassiliou LV, Lalabekyan B, Jay A, Liew C, Whelan J, Newman L, Kalavrezos N. Head and neck sarcomas: A single institute series. Oral Oncol 2016; 65:16-22. [PMID: 28109463 DOI: 10.1016/j.oraloncology.2016.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sarcomas are tumours of mesenchymal origin, accounting for 1% of all malignancies. METHODS This is a retrospective analysis of 107 head and neck sarcoma cases, treated over a period of thirteen years. RESULTS Fifty-four patients had with craniofacial bone sarcomas (BSs) (male: 33; female: 21) with high grade osteosarcoma being the most predominant type. The soft tissue sarcomas (STS) (53 patients; male: 28, female: 25) were histologically diverse with rhabdomyosarcomas and myxofibrosarcomas being the predominant types. The majority of BSs were managed with neoadjuvant chemotherapy followed by surgery, whereas in STSs treatment included predominantly surgery followed by radiotherapy. Overall survival estimates were 79% at 2years and 64% at 5years (mean follow-up period was 48months). CONCLUSIONS The mesenchymal origin of sarcomas, the pattern of disease spread and the different extent of cancellous bone infiltration in contrast to epithelial tumours, dictate distinct principles for surgical clearance.
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Affiliation(s)
| | | | - Amrita Jay
- University College London Hospital (UCLH), London, UK
| | - Colin Liew
- University College London Hospital (UCLH), London, UK
| | - Jeremy Whelan
- University College London Hospital (UCLH), London, UK
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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes. J Laryngol Otol 2016; 130:850-9. [PMID: 27476336 DOI: 10.1017/s0022215116008604] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment. OBJECTIVES This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes. METHODS Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method. RESULTS The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx. CONCLUSION Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.
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Saravakos P, Hartwein J, Fayyazi A. Primary unclassified sarcoma of the parotid gland: a case of diagnostic and therapeutic challenge. Eur Arch Otorhinolaryngol 2016; 274:2343-2347. [PMID: 27423642 DOI: 10.1007/s00405-016-4204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
Malignant salivary gland sarcomas represent a clinically and histologically diagnostic challenge. Primary unclassified sarcomas of the parotid gland consist a rare salivary gland tumor. We report an unusual case of such a tumor, which occurred in the right parotid gland of a 54-year-old male and presented as an asymptomatic painless mass. The pathologoanatomical examination revealed a rhabdoid large-cell unclassified sarcoma. The patient was treated with superficial parotidectomy and adjuvant radiotherapy. No recurrence was noted in a 10-year follow-up period. Due to the rare occurrence of primary unclassified sarcomas, there is no evidence-based treatment of choice. An optimal approach is best planned in a multidisciplinary setting, taking into consideration the resectability of the tumor, individual patient characteristics, presence of local or distant metastatic activity, local infiltrative behavior and tumor stage. A close follow-up of the patient is strongly recommended.
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Affiliation(s)
- Panagiotis Saravakos
- Department of Otorhinolaryngology, Head and Neck Surgery, Siloah St. Trudpert Hospital, Wilferdinger Strasse 67, 75179, Pforzheim, Germany.
| | - Joerg Hartwein
- Department of Otorhinolaryngology, Head and Neck Surgery, Siloah St. Trudpert Hospital, Wilferdinger Strasse 67, 75179, Pforzheim, Germany
| | - Afshin Fayyazi
- Institute of Pathology and Molecular Pathology, Pforzheim Hospital, Kanzlerstrasse 2-6, 75175, Pforzheim, Germany
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Vitzthum LK, Brown LC, Rooney JW, Foote RL. Head and Neck Soft Tissue Sarcomas Treated with Radiation Therapy. Rare Tumors 2016; 8:6165. [PMID: 27441072 PMCID: PMC4935821 DOI: 10.4081/rt.2016.6165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/23/2022] Open
Abstract
Head and neck soft tissue sarcomas (HNSTSs) are rare and heterogeneous cancers in which radiation therapy (RT) has an important role in local tumor control (LC). The purpose of this study was to evaluate outcomes and patterns of treatment failure in patients with HNSTS treated with RT. A retrospective review was performed of adult patients with HNSTS treated with RT from January 1, 1998, to December 31, 2012. LC, locoregional control (LRC), disease-free survival (DFS), overall survival (OS), and predictors thereof were assessed. Forty-eight patients with HNSTS were evaluated. Five-year Kaplan-Meier estimates of LC, LRC, DFS, and OS were 87, 73, 63, and 83%, respectively. Angiosarcomas were found to be associated with worse LC, LRC, DFS, and OS. Patients over the age of 60 had lower rates of DFS. HNSTSs comprise a diverse group of tumors that can be managed with various treatment regimens involving RT. Angiosarcomas have higher recurrence and mortality rates.
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Affiliation(s)
| | - Lindsay C Brown
- Department of Radiation Oncology, Mayo Clinic , Rochester, MN, USA
| | - Jessica W Rooney
- Department of Radiation Oncology, Mayo Clinic , Rochester, MN, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic , Rochester, MN, USA
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Galy-Bernadoy C, Garrel R. Head and neck soft-tissue sarcoma in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:37-42. [DOI: 10.1016/j.anorl.2015.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lindford A, McIntyre B, Marsh R, MacKinnon CA, Davis C, Tan ST. Outcomes of the treatment of head and neck sarcomas in a tertiary referral center. Front Surg 2015; 2:19. [PMID: 26042220 PMCID: PMC4436802 DOI: 10.3389/fsurg.2015.00019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/04/2015] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Andrew Lindford
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington , New Zealand
| | - Benjamin McIntyre
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington , New Zealand
| | - Reginald Marsh
- Gillies McIndoe Research Institute , Wellington , New Zealand
| | - Craig A MacKinnon
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington , New Zealand
| | - Charles Davis
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington , New Zealand
| | - Swee T Tan
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital , Wellington , New Zealand ; Gillies McIndoe Research Institute , Wellington , New Zealand
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Sepúlveda I, Frelinghuysen M, García C, Platin E, Spencer ML, Ortega P, Ulloa D. Giant undifferentiated oropharyngeal sarcoma: a case report and review of the literature. Case Rep Oncol 2014; 7:718-26. [PMID: 25493085 PMCID: PMC4256001 DOI: 10.1159/000368849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report on a patient who presented to the Ear, Nose and Throat (ENT) clinic with swelling of the neck, dysphagia, headache, dyspnea and stridor. Imaging studies revealed an expansive heterogeneous process to the left retropharyngeal region. The mass was ovoid in shape, displaying moderate enhancement after intravenous contrast administration. Subsequently, a biopsy revealed the presence of undifferentiated sarcoma. The patient was treated with chemotherapy followed by radiation therapy, but follow-up exams at 6 months posttreatment revealed that while the tumor was stable, it persisted. Consequently, the patient was enrolled in a palliative care and pain control program and is currently being followed.
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Affiliation(s)
- Ilson Sepúlveda
- ENT-Head and Neck Surgery Service, General Hospital of Concepción, Santiago, Chile ; Finis Terrae University, School of Dentistry, Santiago, Chile
| | | | - Cesar García
- Oncology Service, General Hospital of Concepción, Santiago, Chile
| | - Enrique Platin
- Department of Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, N.C., USA
| | - M Loreto Spencer
- Pathology Department, General Hospital of Concepción, Santiago, Chile
| | - Pablo Ortega
- ENT-Head and Neck Surgery Service, General Hospital of Concepción, Santiago, Chile
| | - David Ulloa
- Private Practice, Concepción, Santiago, Chile
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Szablewski V, Neuville A, Terrier P, Laé M, Schaub R, Garrel R, Coindre JM, Costes V. Adult sinonasal soft tissue sarcoma: analysis of 48 cases from the French Sarcoma Group database. Laryngoscope 2014; 125:615-23. [PMID: 25186315 DOI: 10.1002/lary.24910] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/27/2014] [Accepted: 08/05/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to determine the frequency of primary sinonasal adult sarcoma, identify histological subtypes, and analyze prognostic factors. STUDY DESIGN Retrospective review. METHOD Forty-eight adult sinonasal sarcomas included in the French Sarcoma Group database (Conticabase) were reviewed. RESULTS The most frequent tumor types were alveolar rhabdomyosarcoma (33.3%), embryonal rhabdomyosarcoma (14,6%), unclassified sarcoma (14.6%), and leiomyosarcoma (12.5%). All round cell tumors were rhabdomyosarcomas. The 5-year overall survival (OS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) rates were 62.3%, 73%, and 88.8%, respectively. Histotype was a prognostic factor for OS, MFS, and LRFS, with the worst prognosis associated with rhabdomyosarcomas, regardless of the subtype. The tumor grade influenced the OS and MFS. Surgery was a predictive factor for a complete response. CONCLUSIONS These results suggest that sinonasal tract should be considered as an unfavorable site for rhabdomyosarcoma. Moreover, surgery should always be considered in treatment.
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Affiliation(s)
- Vanessa Szablewski
- Département de pathologie, Centre hospitalo-universiatire Gui de Chauliac
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Park JT, Roh JL, Kim SO, Cho KJ, Choi SH, Nam SY, Kim SY. Prognostic Factors and Oncological Outcomes of 122 Head and Neck Soft Tissue Sarcoma Patients Treated at a Single Institution. Ann Surg Oncol 2014; 22:248-55. [DOI: 10.1245/s10434-014-3870-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Indexed: 11/18/2022]
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31
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Tajudeen BA, Fuller J, Lai C, Grogan T, Elashoff D, Abemayor E, St. John M. Head and neck sarcomas: the UCLA experience. Am J Otolaryngol 2014; 35:476-81. [PMID: 24721744 DOI: 10.1016/j.amjoto.2014.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To profile the clinical presentation, subtype distribution, and treatment results of sarcomas of the head and neck at a single tertiary academic center over an 11-year period. MATERIALS AND METHODS A retrospective review was performed by examining the records and reviewing the pathology of 186 patients with head and neck sarcomas treated at UCLA Medical Center from 2000 to 2011. RESULTS The mean age of the study population was 49 ± 22 years. 58% of the patients were male and 42% were female. Median duration of follow-up for the entire group was 18.5 months. The most common presenting symptom was a mass lesion in 59.9% of patients. The nasal cavity/sinus was the most common presenting site seen in 22% of patients. Solitary fibrous tumor/hemangiopericytoma was the most common subtype. 15% of patients had evidence of prior radiation exposure. 26.3% of tumors were greater than 5 cm and 35.5% were high-grade. Margins were positive in 31.2% of patients. Lymph node metastasis was rare at 6.5%. Perineural invasion was identified in 6.5%. Among all subtypes, 5-year recurrence-free survival and overall survival were 50% and 49%, respectively. Multivariate analysis demonstrated that grade and margin status were predictors of recurrence-free survival while grade and age affected overall survival. CONCLUSIONS Head and neck sarcomas are a rare entity frequently presenting as a mass lesion. In our series, lesions tended to be high-grade with a significant portion of surgical specimens having positive margins. Grade and margin status were the most important predictors of survival.
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Barosa J, Ribeiro J, Afonso L, Fernandes J, Monteiro E. Head and neck sarcoma: Analysis of 29 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:83-6. [DOI: 10.1016/j.anorl.2012.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 10/25/2012] [Accepted: 11/16/2012] [Indexed: 11/30/2022]
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33
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Laffers W, Stöhr G, Göke F, Wardelmann E, Keiner S, Zipfel M, Schüller H, Gerstner A. Weichteiltumoren des Kopf-Hals-Bereichs. HNO 2013; 61:928-36. [DOI: 10.1007/s00106-013-2755-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Mattavelli D, Miceli R, Radaelli S, Mattavelli F, Cantù G, Barisella M, Quattrone P, Stacchiotti S, Sangalli C, Casali P, Gronchi A, Fiore M. Head and neck soft tissue sarcomas: prognostic factors and outcome in a series of patients treated at a single institution. Ann Oncol 2013; 24:2181-9. [DOI: 10.1093/annonc/mdt126] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Tejani MA, Galloway TJ, Lango M, Ridge JA, von Mehren M. Head and neck sarcomas: a comprehensive cancer center experience. Cancers (Basel) 2013; 5:890-900. [PMID: 24202325 PMCID: PMC3795370 DOI: 10.3390/cancers5030890] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/20/2013] [Accepted: 06/18/2013] [Indexed: 11/25/2022] Open
Abstract
Head/neck sarcomas are rare, accounting for about 1% of head/neck malignancies and 5% of sarcomas. Outcomes have historically been worse in this group, due to anatomic constraints leading to difficulty in completely excising tumors, with high rates of local recurrence. We retrospectively analyzed cases of head/neck soft tissue sarcomas (STS) and osteogenic sarcomas managed in a multi-disciplinary setting at Fox Chase Cancer Center from 1999–2009 to describe clinicopathologic characteristics, treatment, outcomes, and prognostic factors for disease control and survival. Thirty patients with STS and seven patients with osteogenic sarcoma were identified. Most STS were high grade (23) and almost all were localized at presentation (28). Common histologies were synovial cell (6), rhabdomyosarcoma (5), angiosarcoma (4), liposarcoma (4) and leiomyosarcoma (3). The type of primary therapy and disease outcomes were analyzed. Cox proportional hazards regression analysis was performed to identify predictors of disease-free survival (DFS) and overall survival (OS). The HR and 95% CI for Cox model and median DFS/OS analyzed by Kaplan-Meier curves were calculated.
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Affiliation(s)
- Mohamedtaki A. Tejani
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA; E-Mail:
| | - Thomas J. Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; E-Mail:
| | - Miriam Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; E-Mails: (M.L.); (J.A.R.)
| | - John A. Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; E-Mails: (M.L.); (J.A.R.)
| | - Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-215-728-2814; Fax: +1-215-728-3639
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36
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Digonnet A, Hamoir M, Andry G, Vander Poorten V, Haigentz M, Langendijk JA, de Bree R, Hinni ML, Mendenhall WM, Paleri V, Rinaldo A, Werner JA, Takes RP, Ferlito A. Follow-up strategies in head and neck cancer other than upper aerodigestive tract squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 270:1981-9. [PMID: 23100081 DOI: 10.1007/s00405-012-2220-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/30/2012] [Indexed: 01/05/2023]
Abstract
Post-therapy follow-up for patients with head and neck cancer other than upper aerodigestive tract squamous cell carcinoma should meet several objectives: to detect both local, regional or distant recurrences, to evaluate acute and long-term treatment-related side effects, to guide the rehabilitation process, and to provide psychosocial support when needed. To our knowledge, there are no published reports in the literature dedicated to the follow-up of patients with these tumours. A comprehensive literature search for post-treatment follow-up strategies spanning from 1980 to 2012 was performed on several databases. This review focuses on malignant salivary gland tumors, soft tissue sarcomas, cutaneous squamous cell carcinomas, and sinonasal adenocarcinomas. Given the varying biological behavior and treatment-related factors and based on the literature, different recommendations are made on the follow-up of patients with the above-mentioned tumors.
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Affiliation(s)
- Antoine Digonnet
- Department of Head and Neck and Thoracic Surgery, Institute Jules Bordet, Brussels, Belgium
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Smith VA, Overton LJ, Lentsch EJ. Head and neck soft tissue sarcomas: unique lack of significance of synchronous node metastases. J Surg Oncol 2012; 106:837-43. [PMID: 22605652 DOI: 10.1002/jso.23148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 04/13/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Regional lymph node metastasis (RLNM) has been identified as a poor prognostic indicator for patients with soft tissue sarcomas (STS) of the extremities and trunk. However, the effect of RLNM on survival in patients with STS of the head and neck (HN) has not previously been explored. Our objective was to analyze RLNM as a prognostic indicator in HN-STS, and to compare this cohort to patients with STS of non-head and neck regions (NHN-STS). METHODS STS patients were identified using the Surveillance, Epidemiology, and End Results database. Only patients without concurrent distant metastasis who underwent surgery and pathologic node staging were included. Patients were categorized based on tumor location: (1) HN-STS and (2) NHN-STS. Clinicopathologic data and disease-specific survival (DSS) were compared between node-negative and node-positive patients in each group. RESULTS We identified 183 cases of node-positive STS (25 HN-STS, 158 NHN-STS). In the HN-STS group, pN1 status was not associated with any of the clinicopathologic factors that we analyzed. DSS was similar among pN0 and pN1 patients with HN-STS (P = 0.59); however, in the NHN-STS group, node-positivity was significantly associated with disease-specific mortality (P < 0.001). CONCLUSIONS Synchronous RLNM may not affect DSS in patients HN-STS. Node-positive patients with HN-STS appear to be unique from those with NHN-STS.
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Affiliation(s)
- Valerie A Smith
- Department of Otolaryngology, Head and Neck Surgery, and Hollings Cancer Center, Medical University of South Carolina, Charleston, USA.
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38
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González-González R, Bologna-Molina R, Molina-Frechero N, Domínguez-Malagon HR. Prognostic factors and treatment strategies for adult head and neck soft tissue sarcoma. Int J Oral Maxillofac Surg 2012; 41:569-75. [PMID: 22398019 DOI: 10.1016/j.ijom.2012.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 10/07/2011] [Accepted: 02/02/2012] [Indexed: 02/07/2023]
Abstract
Adult head and neck soft tissue sarcomas are rare and display a variety of histological types and clinical characteristics; they are also associated with a variety of mortality risks. The purpose of this study was to examine all patients treated at the Instituto Nacional de Cancerologia for head and neck sarcoma during a 5-year period. Fifty-one adult patients were examined and treated for head and neck sarcomas from 2004 to 2009. The 51 tumours were histologically re-evaluated by expert pathologists and classified as low, intermediate or high grade sarcomas. A multivariate analysis was performed to evaluate the surgical margins, histological grades, and clinical stages as prognostic factors for the disease. Adult head and neck soft tissue tumours are rare, and they are associated with poor prognosis for patients, especially at clinical stages III and IV. The average survival rate after 2 years is 45%, and most of these patients die because of disease progression and metastases.
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Affiliation(s)
- R González-González
- Universidad Autónoma Metropolitana, Unidad Xochimilco, UAM, Mexico City, Mexico
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39
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Giant diaphragmatic angiosarcoma of adult: a case report and review of literature. Case Rep Med 2012; 2012:950856. [PMID: 22431944 PMCID: PMC3295565 DOI: 10.1155/2012/950856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 10/28/2011] [Indexed: 01/03/2023] Open
Abstract
Angiosarcoma is a rare vascular malignant soft tissue tumor, with highly malignant, invasive, and multifocal characteristics of biology, which is prone to local recurrence and distant metastasis, so the prognosis is extremely poor. It rarely involves the diaphragm. We present the case of an adult patient who had a primary giant angiosarcoma of the left-sided diaphragm.
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40
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de Bree R, van der Waal I, de Bree E, Leemans CR. Management of adult soft tissue sarcomas of the head and neck. Oral Oncol 2010; 46:786-90. [PMID: 20947413 DOI: 10.1016/j.oraloncology.2010.09.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 12/25/2022]
Abstract
Adult soft tissue sarcoma of the head and neck are rare and represent a heterogeneous group of tumours of different histological variants. Management of these neoplasms presents a great challenge. Malignant fibrous histiocytoma, fibrosarcoma, angiosarcoma and malignant peripheral nerve sheath tumour are the most frequently found sarcoma types in the head and neck. Although traditional morphological assessment is the foundation of clinical decision making, the role of immunohistochemistry and molecular biology are useful for diagnosis, prognosis and identification of possible targets for molecular therapy. The most frequently involved tumour sites are scalp/face, sinonasal tract/anterior skull base and parotid/neck. The management of soft tissue sarcomas in the head and neck is primarily surgical. Since it is difficult to obtain wide margins during surgical treatment in head and neck sarcomas, because of anatomic constraints, most patients undergo post-operative irradiation. Survival varies from 50 to 80%. Prognostic factors are tumour grade, margin status and tumour size. With further insight into the biology of soft tissue sarcoma, modern imaging techniques and new treatment options, we will most certainly be able to improve clinical outcome in patients with soft tissue sarcoma in the upcoming years.
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Affiliation(s)
- Remco de Bree
- Department of Otolaryngology, Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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