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Yoder AK, Farooqi A, Mitra D, Livingston JA, Araujo DM, Sturgis EM, Goepfert R, Bishop AJ, Guadagnolo BA. Outcomes for patients with head and neck sarcoma treated curatively with radiation therapy and surgery. Pract Radiat Oncol 2024:S1879-8500(24)00138-3. [PMID: 38851534 DOI: 10.1016/j.prro.2024.05.006] [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: 02/27/2024] [Revised: 05/10/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Soft tissue sarcomas (STS) of the head and neck (H&N) are rare malignancies that are challenging to manage. We sought to describe the outcomes of patients treated with curative intent using combined surgery and radiation therapy (RT) for H&N STS. METHODS We performed a single-institution retrospective review of patients with non-metastatic STS of the H&N who were treated from 1968-2020. The Kaplan-Meier method was used to estimate disease-specific survival (DSS) and local control (LC). Multivariable analyses (MVA) were conducted using Cox proportional hazards model. RESULTS 192 pts had a median follow-up of 82 months. Tumors arose in the neck (n=50, 26%), paranasal sinuses (n=36, 19%), or face (n=23, 12%). Most patients were treated with post-operative RT (n=134, 70%). Post-op RT doses were higher (median 60Gy, pre-op 50Gy, p<0.001). Treatment sequence was not associated with LC (pre-op RT 78% (63-88), post-op RT 75% (66-82), p=0.48). On MVA, positive/uncertain margin was the only variable associated with LC (HR 2.54 (1.34-4.82), p=0.004). LC was significant on MVA (HR 4.48 (2.62-7.67), p<0.001) for DSS. Patients who received post-op RT were less likely to experience a major wound complication (MWC) (7.5% vs 22.4%, HR 0.28 (0.11-0.68), p=0.005). There was no difference in the rate of late toxicities between patients who received pre-op or post-op RT. CONCLUSIONS H&N STS continues to have relatively poorer LC than STS of the trunk or extremities. We found LC to be associated with DSS. Timing of RT did not impact oncologic or long-term toxicity outcomes, however pre-op RT did increase the chance of developing a MWC.
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Affiliation(s)
- Alison K Yoder
- MD Anderson Cancer Center, Department of Radiation Oncology
| | - Ahsan Farooqi
- MD Anderson Cancer Center, Department of Radiation Oncology.
| | - Devarati Mitra
- MD Anderson Cancer Center, Department of Radiation Oncology
| | | | - Dejka M Araujo
- MD Anderson Cancer Center, Department of Sarcoma Medical Oncology
| | - Erich M Sturgis
- Baylor College of Medicine, Department of Otolaryngology - Head and Neck Surgery
| | - Ryan Goepfert
- MD Anderson Cancer Center, Department of Head and Neck Surgery
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2
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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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Tapan M, İsler VC, Akman RF, Özkan Ö, Özkan Ö. An Oroauricular Fistula After Mandibular Osteosarcoma Resection. HANDCHIR MIKROCHIR P 2023; 55:462-465. [PMID: 37678410 DOI: 10.1055/a-2125-0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Bone tumors are rare malignancies and osteosarcoma is the most common malignant bone tumor. However, only 6% of all osteosarcomas occur in the mandible and maxilla 1. The location of these tumors also presents a unique set of challenges during resection and repair when compared to long bone tumors.
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4
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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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Wu Q, Wang J, Li S, Liu J, Cheng Y, Jin J, Zhong Y. Comparison of Definitive Radiotherapy-Based Treatment and Surgical-Based Treatment for Locally Advanced Head and Neck Soft Tissue Sarcoma. J Clin Med 2023; 12:jcm12093099. [PMID: 37176541 PMCID: PMC10179011 DOI: 10.3390/jcm12093099] [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: 02/09/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Background: Head and neck soft-tissue sarcomas are rare but aggressive malignancies. Definitive radiotherapy might be an alternative treatment choice in patients unfit for surgery with preservation of organ function and facial morphology. Whether definitive radiotherapy is comparable with surgery has not been fully demonstrated. In this study, we compared the prognosis of patients with radiotherapy-based treatment and with surgery-based treatment. Methods: From May 2014 to February 2021, patients with locally advanced head and neck soft-tissue sarcoma treated with either definitive radiotherapy-based treatment or radical surgery-based treatment were retrospectively enrolled. Clinical outcomes including tumor response, patients' survival and acute treatment-related toxicities were evaluated. Kaplan-Meier curves with log-rank test were used to compare survival data. Cox regression analysis was used to explore prognostic factors. Results: A total of 24 patients (12 males and 12 females, 3 to 61 years old) were eligible for analysis. The median follow-up time was 49 (range: 6-96) months. In 16 patients receiving definitive radiotherapy-based treatment, 6 reached complete response. The survival curve showed that there was no statistically significant difference in overall survival (OS), distant metastasis-free survival (DMFS), loco-regional relapse-free survival (LRRFS) and progression-free survival (PFS) between the two groups of patients (p = 0.35, p = 0.24, p = 0.48, p = 0.1, respectively). COX regression analysis showed that older age was associated with poor DMFS. There was no significant difference in grade 3-4 toxicities between the two groups. Conclusions: In cases of contradictions to surgery, refusal to surgery or failure to complete resection, chemoradiotherapy might be an alternative treatment option.
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Affiliation(s)
- Qiuji Wu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Juan Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Shaojie Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jia Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yanshuang Cheng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jieying Jin
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yahua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Fyrmpas G, Barkoulas E. Isolated Malignant Peripheral Nerve Sheath Tumor of the Scalp. EAR, NOSE & THROAT JOURNAL 2023; 102:NP104-NP105. [PMID: 33624549 DOI: 10.1177/0145561321991317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Georgios Fyrmpas
- Department of Otolaryngology, General District Hospital of Katerini, Neo Keramidi, Katerini, Greece
| | - Efstathios Barkoulas
- Department of Otolaryngology, General District Hospital of Katerini, Neo Keramidi, Katerini, Greece
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7
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Cavalcante IL, Cunha JLS, da Silva CCB, Nonaka CFW, Cavalcante ER, de Almeida OP, Ribeiro NRB, Turatti E, Cavalcante RB, de Andrade BAB. Gingival rhabdomyosarcoma mimicking a non-neoplastic proliferative lesion: A diagnostic challenge. Oral Oncol 2023; 137:106281. [PMID: 36549241 DOI: 10.1016/j.oraloncology.2022.106281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Rhabdomyosarcoma (RMS) is a soft tissue sarcoma that develops from skeletal striated muscle cells. RMSs are exceedingly rare in the oral cavity, particularly in the gingiva. Herein, we reported the clinicopathological and immunohistochemical features of a rare case of RMS in a 30-year-old female presenting clinically as a painful polypoid nodule on the mandibular gingiva. Microscopically, the tumor showed atypical spindle cells with elongated nuclei and eosinophilic cytoplasm arranged in a fascicular pattern. In focal areas, the tumor cells exhibited rhabdomyoblastic differentiation. Immunohistochemistry showed strong positivity for desmin, myogenin (scattered cells), and MyoD1. The patient underwent surgical resection followed by postoperative complementary radio- and chemotherapy. However, the patient had a local recurrence seven months after the initial treatment. She was submitted to a total mandibulectomy associated with adjuvant radiotherapy. However, she died two months after reoperation due to complications secondary to radiation therapy. Because of the rarity in the oral cavity and non-specific signs and symptoms, the clinical diagnosis of RMS is difficult and often overlooked. Therefore, careful histopathological and immunohistochemistry analysis of these tumors is essential to correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up are strongly recommended.
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Affiliation(s)
- Israel Leal Cavalcante
- Department of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil; Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - John Lennon Silva Cunha
- Department of Dentristy, State University of Paraíba (UEPB), Campina Grande, Brazil; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
| | - Caio Cesar Barros da Silva
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Eveline Turatti
- Department of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil.
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Current Insights and Progress in the Clinical Management of Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14246079. [PMID: 36551565 PMCID: PMC9776832 DOI: 10.3390/cancers14246079] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Head and neck cancer (HNC), also known as the cancer that can affect the structures between the dura mater and the pleura, is the 6th most common type of cancer. This heterogeneous group of malignancies is usually treated with a combination of surgery and radio- and chemotherapy, depending on if the disease is localized or at an advanced stage. However, most HNC patients are diagnosed at an advanced stage, resulting in the death of half of these patients. Thus, the prognosis of advanced or recurrent/metastatic HNC, especially HNC squamous cell carcinoma (HNSCC), is notably poorer than the prognosis of patients diagnosed with localized HNC. This review explores the epidemiology and etiologic factors of HNC, the histopathology of this heterogeneous cancer, and the diagnosis methods and treatment approaches currently available. Moreover, special interest is given to the novel therapies used to treat HNC subtypes with worse prognosis, exploring immunotherapies and targeted/multi-targeted drugs undergoing clinical trials, as well as light-based therapies (i.e., photodynamic and photothermal therapies).
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9
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Habib A, Edem I, Bell D, Su SY, Hanna EY, Kupferman ME, DeMonte F, Raza SM. Soft Tissue Sarcomas of the Head and Neck Region with Skull Base/Intracranial Invasion: Review of Surgical Outcomes and Multimodal Treatment Strategies: A Retrospective Case Series. Curr Oncol 2022; 29:6540-6550. [PMID: 36135083 PMCID: PMC9498209 DOI: 10.3390/curroncol29090514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
Soft tissue sarcomas (STS) invading the skull base are rare with little data to guide surgical management. Here we aimed to determine the factors affecting tumor control rates and survival in patients with T4 stage head and neck STS involving the skull base. A retrospective review of STS patients, surgically treated at our institution between 1994 and 2017 was conducted. Variables were collected and assessed against progression-free survival. Tumors were graded using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) system. A total of 51 patients (mean age of 35) were included, of whom 17 (33.3%) patients were FNCLCC grade 1, 8 (15. 7%) were FNCLCC grade 2 and 26 (51%) were FNCLCC grade 3. The median PFS was 236.4 months while the 5- and 10-year PFS rates were 44% and 17%, respectively. Recurrence occurred in 17 (33.3%) patients. Local recurrence occurred in 10 (58.8%). Univariate analysis revealed R0 resection had a near-significant impact on tumor control in radiation-naïve patients. Otherwise, prior radiation (HR 6.221, CI 1.236–31.314) and cavernous sinus involvement (HR 14.464, CI 3.326–62.901) were negative predictors of PFS. The most common cause of treatment failure was local recurrence. In T4 stage head and neck STS with skull-base involvement, FNCLCC grade, radiation status, and anatomic spread should be considered in determining the overall treatment strategy.
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Affiliation(s)
- Ahmed Habib
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Idara Edem
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shirley Y. Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael E. Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shaan M. Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +713-792-2400; Fax: 713-794-4950
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Epithelioid Hemangioendothelioma with WWTR1-CAMTA1 Fusion in the Parotid Gland Presenting as Bell’s Palsy. Case Rep Pathol 2022; 2022:5687190. [PMID: 35784660 PMCID: PMC9249508 DOI: 10.1155/2022/5687190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022] Open
Abstract
Epithelioid hemangioendothelioma is a rare tumor of endothelial differentiation most commonly arising in soft tissue, liver, and lung, following a variable clinical course. Most cases are characterized by a t(1;3)(p36;q23-25) resulting in WWTR1-CAMTA1 fusion. Only five epithelioid hemangioendothelioma have been previously reported arising in the salivary glands. None have presented as Bell’s palsy. In the current case, a 37-year-old female presented with a longstanding complaint of pain and fullness in the right preauricular region and progressive episodes of Bell’s palsy and facial nerve weakness. Surgical resection showed a tumor comprised of atypical cells with occasional intracytoplasmic vacuoles in a fibromyxoid stroma. Immunohistochemical stains demonstrated the neoplastic cells expressed ERG, CD31, and CD34, confirming vascular differentiation. Fluorescence in situ hybridization revealed a t(1;3)(p36;q25), confirming a diagnosis of epithelioid hemangioendothelioma. At 12-month follow-up, the patient has no evidence of disease.
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11
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Ferrari M, Mattavelli D, Tomasoni M, Raffetti E, Bossi P, Schreiber A, Orlandi E, Taboni S, Rampinelli V, Gualtieri T, Turri-Zanoni M, Battaglia P, Arosio AD, Bignami M, Tartaro T, Molteni M, Bertazzoni G, Fiaux-Camous D, Jourdaine C, Verillaud B, Eu D, Nair D, Moiyadi A, Shetty P, Ghosh-Laskar S, Budrukkar A, Magrini SM, Guillerm S, Faivre S, Piazza C, Gilbert RW, Irish JC, de Almeida JR, Pai P, Herman P, Castelnuovo P, Nicolai P. The MUSES∗: a prognostic study on 1360 patients with sinonasal cancer undergoing endoscopic surgery-based treatment: ∗MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers. Eur J Cancer 2022; 171:161-182. [PMID: 35724468 DOI: 10.1016/j.ejca.2022.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the last 2 decades, transnasal endoscopic surgery (TES) has become the most frequently employed surgical technique to treat sinonasal malignancies. The rarity and heterogeneity of sinonasal cancers have hampered large non-population-based analyses. METHODOLOGY All patients receiving TES-including treatment between 1995 and 2021 in 5 referral hospitals were included. A prognostic study was performed, and multivariable models were transformed into nomograms. Training and validation sets were based on results from 3 European and 2 non-European centres, respectively. RESULTS The training and validation set included 940 and 420 patients, respectively. The mean age at surgery, primary-versus-recurrent presentation, histology distribution, type of surgery, T category and type of adjuvant treatment were differently distributed in the training and validation set. In the training set, 5-year overall survival and recurrence-free survival with a 95%-confidence interval were 72.7% (69.5-76.0%) and 66.4% (63.1-69.8%), respectively, significantly varying with histology. At multivariable analyses, age, gender, previous treatment, the extent of resection on the cranial, lateral and posterolateral axes, grade/subtype, T category, nodal status, margin status and adjuvant treatment were all associated with different prognostic outcomes, displaying a heterogeneous significance and effect size according to histology. The internal and external validation of nomograms was satisfactory (optimism-corrected C-index >0.7 and cumulative area under curve >0.7) for all histologies but mucosal melanoma. CONCLUSIONS Outcomes of TES-based treatment of sinonasal cancers vary substantially with histology. This large, non-population-based study provides benchmark data on the prognosis of sinonasal cancers that are deemed suitable for treatment including TES.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto D Arosio
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Marinella Molteni
- Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | | | | | - Clement Jourdaine
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Benjamin Verillaud
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Donovan Eu
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Deepa Nair
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Stefano M Magrini
- Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Sophie Guillerm
- Department of Radiotherapy Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Sandrine Faivre
- Department of Medical Oncology Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Prathamesh Pai
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Philippe Herman
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
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Wannapanich T, Pratipanawat P. Primary orbital pleomorphic liposarcoma in a child: A case report. Am J Ophthalmol Case Rep 2022; 25:101285. [PMID: 35146183 PMCID: PMC8818483 DOI: 10.1016/j.ajoc.2022.101285] [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: 02/26/2021] [Revised: 09/14/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a rare case of primary orbital pleomorphic liposarcoma and present a relevant literature review. Observations An 11-year-old boy presented with an enlarging, painless lower right eyelid mass that was noted 4 months ago. Imaging revealed a 3.2 × 2.1 × 3.7-cm-sized well-circumscribed lobulated mass. Biopsy revealed a pleomorphic spindle cell neoplasm that was consistent with a pleomorphic liposarcoma. A systemic evaluation found no evidence of distant metastasis. Despite four chemotherapy cycles, the mass size increased at follow-up. Total orbital exenteration was performed 1 year after confirming a diagnosis of pleomorphic liposarcoma. At the 6-month follow-up, the patient was alive with no signs of recurrence. Conclusions Pediatric pleomorphic liposarcoma is a very rare entity. Its definite diagnosis relies on histopathological results. In the absence of systemic metastasis, total orbital exenteration is the optimal approach for local control.
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Kotecha S, Williams MA, White HB, Graystone J, Gibbons M, Cosker T. Head and neck sarcoma: three-year data from a tertiary referral centre. Ann R Coll Surg Engl 2021; 103:762-767. [PMID: 34448646 DOI: 10.1308/rcsann.2021.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sarcomas of the head and neck are neoplasms arising from the embryonic mesenchyme. They are rare and heterogeneous in nature and are associated with significant morbidity and mortality. This study evaluates patients referred to the Oxford Sarcoma Service, a tertiary referral centre. METHODS Patients discussed over a three-year period were included. Medical records were analysed using the electronic patient record database. Data were acquired on a range of domains, including: demographics, histopathology, treatment modality, recurrence, mortality, survival, etc. RESULTS Thirty-two eligible patients, 21 male and 11 female, were identified with a mean age of 58 years; 26 out of 32 patients had high-grade sarcomas. The commonest histological subtype was chondrosarcoma (8/32). Twenty-two underwent planned multidisciplinary team surgical resection after biopsy and staging: negative margins were noted in 9, with close and involved margins in 5 and 8, respectively. Local recurrence was noted in 13 and 6 had metastatic disease out of the 32 eligible patients. Mortality was noted in 10 out of 32 patients. Mean survival was 69.5 months. Five-year overall survival was 64%. Surgery demonstrated statistically significant improvement in survival (p=0.0095). There were no significant differences in survival, recurrence or marginal status between methods of adjuvant or neoadjuvant therapy. CONCLUSION Outcomes of head and neck sarcomas are inferior compared with other types of sarcoma. The nature of the complex surrounding anatomy presents unique challenges in surgical management. This in turn affects rates of local recurrence and prognosis. Therefore, it is critical that they are managed in tertiary, specialist centres with a multidisciplinary approach.
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Affiliation(s)
- S Kotecha
- Oxford University Hospitals NHS Foundation Trust, UK
| | - M A Williams
- Oxford University Hospitals NHS Foundation Trust, UK
| | | | - J Graystone
- Oxford University Hospitals NHS Foundation Trust, UK
| | - M Gibbons
- Oxford University Hospitals NHS Foundation Trust, UK
| | - T Cosker
- Oxford University Hospitals NHS Foundation Trust, UK
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14
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Chandra SR, Das S, Wolf A. Parotid Neurogenic Tumors: MPNST Sarcoma to Schwannoma-Review of Literature and Guidelines in Management. J Maxillofac Oral Surg 2021; 20:356-363. [PMID: 34408362 DOI: 10.1007/s12663-021-01523-2] [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: 05/13/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022] Open
Abstract
Objective To delineate a distinct clinical, pathological, cytoimmunohistochemical distinguishing features of extracranial parotid neurogenic tumors. Pleomorphic adenoma, the most common parotid neoplasm by itself can mimic a neurogenic tumor, i.e., schwannoma. We have reported such rare entity in earlier publications. This is a systematic review with a case discussion of the third only documented malignant peripheral nerve sheath tumor (MPNST) arising in the parotid in a noncontiguous fashion. We review the management, diagnostic immunohistochemistry of this low-grade sarcoma, which has not been documented thus far. Purpose Significant diagnostic and management pitfalls may occur even with fine-needle aspiration or biopsy, as they will not be ideal in diagnosis of parotid neurogenic neoplasms preoperatively. Ultrasound as well as magnetic resonance imaging may not offer a specific facial nerve course in association to the neoplastic lesion. Majority of the neurogenic tumors can be misdiagnosed and hence, improperly managed leading to facial nerve injury and tumor morbidity. Due to the lack of ideal diagnostic modality and morbidity of facial nerve injury, a thorough review of differential diagnosis inclusive of neurogenic tumors of the parotid is to be considered in indications of surgical approaches. We retrospectively review successful resection with preservation of facial nerve function in our parotid neurogenic tumors. Conclusion The objective of this paper is to review the guidelines and treatment planning of parotid neurogenic tumors.
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Affiliation(s)
- Srinivasa Rama Chandra
- Division of OMF-Head and Neck Surgery, Department of Surgery, 98415 Nebraska Medical Centre, University of Nebraska Medical Centre, Omaha, NE 68198-4125 USA
| | - Shibani Das
- Department of Plastic and Maxillofacial Surgery, Ashwini Hospital, Cuttack, Odisha India
| | - Alejandro Wolf
- Division of OMF-Head and Neck Surgery, Department of Surgery, 98415 Nebraska Medical Centre, University of Nebraska Medical Centre, Omaha, NE 68198-4125 USA
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15
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American Brachytherapy Society (ABS) consensus statement for soft-tissue sarcoma brachytherapy. Brachytherapy 2021; 20:1200-1218. [PMID: 34303600 DOI: 10.1016/j.brachy.2021.05.011] [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: 04/17/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Growing data supports the role of radiation therapy in the treatment of soft tissue sarcoma (STS). Brachytherapy has been used for decades in the management of STS and can be utilized as monotherapy or as a boost to external beam radiation. We present updated guidelines from the American Brachytherapy Society regarding the utilization of brachytherapy in the management of STS. METHODS AND MATERIALS Members of the American Brachytherapy Society with expertise in STS and STS brachytherapy created an updated clinical practice guideline including step-by-step details for performing STS brachytherapy based on a literature review and clinical experience. RESULTS Brachytherapy monotherapy should be considered for lower-recurrence risk patients or after a local recurrence following previous external beam radiation; a brachytherapy boost can be considered in higher-risk patents meeting implant criteria. Multiple dose/fractionation regimens are available, with determination based on tumor location and treatment intent. Techniques to limit wound complications are based on the type of wound closure; wound complication can be mitigated with a delay in the start of brachytherapy with immediate wound closure or by utilizing a staged reconstruction technique, which allows an earlier treatment start with a delayed wound closure. CONCLUSIONS These updated guidelines provide clinicians with data on indications for STS brachytherapy as well as guidelines on how to perform and deliver high quality STS brachytherapy safely with minimal toxicity.
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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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Chen N, Yuan H, Fan W, Ma L, Liu K, Chen L, Yang S, Zhang X. Multimodal Treatment With Orbital Organ Preservation in Adult Patients With Locally Advanced Small-Round-Cell Malignancy of the Nasal Cavity and Paranasal Sinus. Front Oncol 2021; 11:650385. [PMID: 33869053 PMCID: PMC8047626 DOI: 10.3389/fonc.2021.650385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the efficacy of induction chemotherapy followed by concurrent chemotherapy and helical tomotherapy in adult patients with locally advanced small-round-cell malignancy of the nasal cavity and paranasal sinus in regard to orbital organ preservation and quality of life. Methods The clinical data of 49 patients with orbital involvement of locally advanced small-round-cell malignancy of the nasal cavity and paranasal sinus who received multimodal treatment for orbital organ preservation between December 2009 and January 2019 were retrospectively analyzed. Treatment efficacy and side effects were assessed. The study included three different pathological types. All patients were treated with induction chemotherapy followed by concurrent chemoradiotherapy. Helical tomotherapy was applied as radiotherapy. Adverse reactions to the chemotherapy were assessed according to Common Terminology Criteria for Adverse Events, Version 3. The overall survival (OS) rate, progression-free survival (PFS) rate, and orbital preservation rate were calculated using the Kaplan-Meier method. Results After multimodal treatment, the 3- and 5-year OS rates of the 49 patients were 63.8% and 54.5%, respectively, and the 3- and 5-year total PFS rates were 66.8% and 63.1%, respectively. Conclusions Multimodal treatment can preserve the orbital organs of adult patients with small-round-cell malignancy of the nasal cavity and paranasal sinus, achieve relatively ideal organ protection and survival rates, and improve quality of life, thus providing a new treatment option for these patients.
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Affiliation(s)
- Nanxiang Chen
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Hu Yuan
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Wenjun Fan
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Oncology, Armed Police Corps Hospital of Henan Province, Zhengzhou, China
| | - Lin Ma
- Department of Radiation Oncology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Kun Liu
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Lei Chen
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Shiming Yang
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Xinxin Zhang
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
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Correia Neto IJ, Cunha JLS, de Oliveira CE, de Almeida OP, Aciole GTDS, Freitas MMD, Albuquerque-Júnior RLCD. A recurrent leiomyosarcoma of the buccal mucosa: An immunohistochemistry study and literature review. Oral Oncol 2021; 120:105257. [PMID: 33722494 DOI: 10.1016/j.oraloncology.2021.105257] [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: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022]
Abstract
Leiomyosarcoma is a rare type of cancer that affects smooth muscle tissue. Leiomyosarcomas are exceedingly rare in the oral cavity, particularly in the buccal mucosa. The diagnosis is challenging due to non-specific clinical features and significant overlap of morphological findings with several spindle cell tumors. We reported the clinicopathological and immunohistochemical features of a rare recurrent case of leiomyosarcoma in a 73-year-old female presenting clinically as a painful nodule on the posterior right buccal mucosa. Microscopically, the lesion showed atypical spindle cells arranged in a fascicular pattern and frequent mitotic figures. Immunohistochemistry showed strong positivity for vimentin, α-SMA, HHF35, h-caldesmon, and focal positivity for desmin. CD34 highlighted numerous blood vessels distributed throughout all tumor stroma. S-100 protein, myogenin, and pan-cytokeratin (AE1/AE3) were negative. Surgical excision followed by chemotherapy was carried out, and no recurrence was observed after 1 year of follow-up. Careful histopathological and immunohistochemistry analysis of these lesions is essential to ensure a correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up is strongly recommended.
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Affiliation(s)
- Ivan José Correia Neto
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
| | - John Lennon Silva Cunha
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
| | - Carlos Eduardo de Oliveira
- Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research, Tiradentes University (UNIT), Aracaju, SE, Brazil
| | - Oslei Paes de Almeida
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | - Margarite Maria Delmondes Freitas
- Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research, Tiradentes University (UNIT), Aracaju, SE, Brazil
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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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20
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Brust K, Nogal P, Miętkiewska-Leszniewska D, Iwanik K, Krasiński Z, Wierzbicka M. Skull base trauma: Masking, stimulating or neutral factor for the insidious development of angiosarcoma in a 19-year-old. Oral Oncol 2021; 117:105214. [PMID: 33579633 DOI: 10.1016/j.oraloncology.2021.105214] [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: 01/10/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
Angiosarcoma is a malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas, uncommonly found in the head and neck region. The etiology is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Presented here is a case of a patient treated due to the skull base trauma and diagnosed with this type of tumor.
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Affiliation(s)
- K Brust
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland
| | - P Nogal
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland.
| | - D Miętkiewska-Leszniewska
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland
| | - K Iwanik
- Department of Clinical Pathomorphology, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland
| | - Z Krasiński
- Department of Vascular Surgery, Poznan University of Medical Sciences, Długa Street 1/2, 61- 848 Poznań, Poland
| | - M Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland
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Surgical Advances in Osteosarcoma. Cancers (Basel) 2021; 13:cancers13030388. [PMID: 33494243 PMCID: PMC7864509 DOI: 10.3390/cancers13030388] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Osteosarcoma (OS) is the most common bone cancer in children. OS most commonly arises in the legs, but can arise in any bone, including the spine, head or neck. Along with chemotherapy, surgery is a mainstay of OS treatment and in the 1990s, surgeons began to shift from amputation to limb-preserving surgery. Since then, improvements in imaging, surgical techniques and implant design have led to improvements in functional outcomes without compromising on the cancer outcomes for these patients. This paper summarises these advances, along with a brief discussion of future technologies currently in development. Abstract Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.
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From head and neck lipoma to liposarcoma: a wide spectrum of differential diagnoses and their therapeutic implications. Curr Opin Otolaryngol Head Neck Surg 2020; 28:136-143. [PMID: 32011399 DOI: 10.1097/moo.0000000000000608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To overview the array of differential diagnoses among lipomatous tumours of the head and neck with special focus on their evaluation, three-dimensional assessment, and their available treatments. RECENT FINDINGS The head and neck is an infrequent localization for lipomatous tumours, even though they represent the most common mesenchymal lesions. Lipoma, spindle cell/pleomorphic lipoma (SC/PL), atypical lipomatous tumour/well differentiated liposarcoma (ALT/WDLPS), de-differentiated liposarcoma (DDLPS), myxoid liposarcoma (MLPS), and pleomorphic liposarcoma (PLPS) are the most distinctive histotypes. Lipoma and SC/PL present alterations of chromosomes 12 and 13, ALT/WDLPS and DDLPS both show the Mouse Double Minute 2 amplification, whereas MLPS presents a CHOP gene fusion. Diagnosis of PLPS is purely morphological as there is no pathognomonic genetic alteration identified to date. Radiological assessment can be challenging for the presence of nonadipose components within the lesion. Surgery is the mainstay of treatment, even though achieving true radicality in terms of a large cuff of healthy tissue surrounding the tumour is not always realistic in the head and neck. Adjuvant radiation, eventually in combination with systemic chemotherapy, has been shown to improve overall survival in patients with positive margins, high-grade, deep, and more than 5 cm lesions. Further studies should be aimed at the evaluation of the role of hadron therapy, as well as targeted drugs against overexpressed proteins. SUMMARY Adequate differential diagnosis of the histotypes collected under the umbrella term of head and neck lipomatous tumours plays a fundamental role in treatment and follow-up of these lesions and requires specific expertise with referral to high-volume centres.
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Endoscope-assisted resection of residual parapharyngeal liposarcoma: A case report. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Palmer JD, Gamez ME, Ranta K, Ruiz-Garcia H, Peterson JL, Blakaj DM, Prevedello D, Carrau R, Mahajan A, Chaichana KL, Trifiletti DM. Radiation therapy strategies for skull-base malignancies. J Neurooncol 2020; 150:445-462. [PMID: 32785868 DOI: 10.1007/s11060-020-03569-7] [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: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The management of skull base malignancies continues to evolve with improvements in surgical technique, advances in radiation delivery and novel systemic agents. METHODS In this review, we aim to discuss in detail the management of common skull base pathologies which typically require multimodality therapy, focusing on the radiotherapeutic aspects of care. RESULTS Technological advances in the administration of radiation therapy have led to a wide variety of different treatment strategies for the treatment of skull base malignances, with outcomes summarized herein. CONCLUSION Radiation treatment plays a key and critical role in the management of patients with skull base tumors. Recent advancements continue to improve the risk/benefit ratio for radiotherapy in this setting.
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Affiliation(s)
- J D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M E Gamez
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - K Ranta
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Blakaj
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Prevedello
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R Carrau
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - K L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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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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Aalling M, Klug TE, Ovesen T. Head and neck sarcomas: the first report addressing the duration of symptoms and diagnostic work up. Acta Otolaryngol 2020; 140:521-525. [PMID: 32186247 DOI: 10.1080/00016489.2020.1733656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Head and neck sarcomas are rare and difficult to diagnose and manage.Aim: To describe a population of patients with head and neck sarcomas focusing on the effect of symptom duration and time to diagnosis on mortality and recurrence risk.Materials and methods: Fifty-one patients treated in our department between 1998-2013 were retrospectively included. Patient and tumour characteristics as well as dates of interest were obtained from sarcoma registries, charts and pathology records. The effect of symptom duration and time to diagnosis on mortality and risk of recurrence was tested by multivariate analysis.Results: There was a wide range in symptom duration (1-144 months, median 5) and time for diagnosis (0-234 days, median 14) without significant effect on overall mortality, disease-specific mortality or risk of recurrence. Chondrosarcomas in the larynx dominated among the patients with the longest diagnostic duration.Conclusion and significance: The diagnostic process is challenging and in some cases of extremely long duration without effect on mortality. The symptom duration and time to diagnosis in relation to mortality and risk of recurrence has not previously been described. Early biopsy, better imaging and advanced pathological techniques can hopefully speed up the diagnostic process and reduce morbidity and mortality.
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Affiliation(s)
- Mathilde Aalling
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head & Neck Surgery, Region Hospital West Jutland, Holstebro, Denmark
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Cubas Farinha N, Belo D, Freitas H, Coiteiro D. Giant Malignant Peripheral Nerve Sheath Tumor of the Scalp: Case Report and Review of the Literature. World Neurosurg 2020; 138:246-252. [PMID: 32179188 DOI: 10.1016/j.wneu.2020.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are rare nervous system tumors that rarely appear on the scalp. About half of the scalp MPNSTs described in the literature have reached giant dimensions at the time of diagnosis. The surgical treatment is the gold standard for this type of tumor. Some authors suggest adjuvant radiotherapy for local tumor control, although there is uncertainty about its advantages and its use is not without risks. CASE DESCRIPTION We present the case of a 31-year-old man who presented with a large necrotic scalp tumor of the left frontoparietal convexity. magnetic resonance imaging showed a large extra-axial tumor, measuring 17 x 17 x 8 cm, centered on the soft tissues, with skull erosion and signs of dural invasion, although with no intradural component. The tumor was surgically removed and the osteocutaneous defect was reconstructed with a latissimus dorsi muscle free flap. The anatomopathologic diagnosis was MPNST. The patient then underwent adjuvant radiotherapy. After 7 months he developed a progressive right hemiparesis and magnetic resonance imaging showed results compatible with cerebral radiation necrosis. This motor deficit improved with corticotherapy. After 9 months the patient went back to his home country and was subsequently lost to follow-up. CONCLUSIONS Giant MPNSTs of the scalp are highly aggressive lesions that should primarily be treated in a surgical fashion. Although adjuvant radiotherapy has been used routinely for local tumor control, there is uncertainty about its advantages.
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Affiliation(s)
- Nuno Cubas Farinha
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.
| | - Diogo Belo
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Hugo Freitas
- Department of Plastic and Reconstructive Surgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Domingos Coiteiro
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
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de Carvalho WRS, de Souza LL, Pontes FSC, Uchôa DCC, Corrêa DL, de Cáceres CVBL, Lopes MA, Santos-Silva AR, Vargas PA, de Andrade BAB, Romañach M, Gomez RS, Costa SFDS, Batista AC, Mendonça EF, Pinto DDS, Gondak R, da Cruz Perez DE, Nonaka C, Dos Santos JN, Libório-Kimura TN, Câmara J, Ramôa Pires F, de Souza LB, Martins MD, de Almeida OP, Fonseca FP, Pontes HAR. A multicenter study of oral sarcomas in Brazil. Oral Dis 2019; 26:43-52. [PMID: 31605560 DOI: 10.1111/odi.13211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the prevalence of oral sarcomas from geographic regions of Brazil. MATERIALS AND METHODS A cross-sectional study was conducted on biopsies obtained from January 2007 to December 2016 at twelve Brazilian oral and maxillofacial pathology centres. Gender, age, evolution time, clinical aspects, tumour location, tumour size at diagnosis, radiographic aspects and histopathological diagnosis were evaluated. Data were analysed using descriptive statistical methods. RESULTS From 176,537, a total of 200 (0.11%) oral sarcomas were reported, and the most prevalent were osteosarcomas (74 cases; 37%) and Kaposi's sarcomas (52 cases; 26%). Males were more affected than females at a mean age of 32.2 years old (range of 3-87 years). The most common symptoms were swelling¸ localised pain and bleeding at a mean evolution time of 5.14 months (range <1-156 months). The lesions were mostly observed in the mandible (90 cases; 45%), with a mean tumour size of 3.4 cm (range of 0.3-15 cm). Radiographically, the lesions presented a radiolucent aspect showing cortical bone destruction and ill-defined limits. CONCLUSIONS Oral sarcomas are rare lesions with more than 50 described subtypes. Osteosarcomas and Kaposi's sarcomas were the main sarcomas of the oral cavity in Brazil.
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Affiliation(s)
- Waldner Ricardo Souza de Carvalho
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil.,Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Lucas Lacerda de Souza
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | | | | | - Davi Lavareda Corrêa
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | | | - Márcio Ajudarte Lopes
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Mário Romañach
- Oral Pathology, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sara Ferreira Dos Santos Costa
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Rogério Gondak
- Department of Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Cassiano Nonaka
- Post-graduate Program of Dentistry, State University of Paraíba, Campina Grande, Brazil
| | - Jean Nunes Dos Santos
- Laboratory of Oral Surgical Pathology, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | | | - Jeconias Câmara
- Department of Pathology and Legal Medicine, Federal University of Amazonas, Manaus, Brazil
| | - Fábio Ramôa Pires
- Oral Pathology, Dental School, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lélia Batista de Souza
- Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Manoela Domingues Martins
- Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Oslei Paes de Almeida
- Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil.,Oral Diagnosis Department (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Comparison of prognostic implications between the 7th and 8th edition of AJCC TNM staging system for head and neck soft-tissue sarcoma in adult patients. Eur Arch Otorhinolaryngol 2019; 276:3195-3202. [PMID: 31399768 DOI: 10.1007/s00405-019-05584-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to investigate the prognostic factors for head and neck soft-tissue sarcoma (HNSTS) in adults, with the comparisons between the 7th and 8th edition of AJCC TNM staging system. METHODS From a cancer registry of a single, tertiary referral medical center, the medical records of 67 patients treated from February 2005 to December 2017 were reviewed. RESULTS T1b stage by AJCC 7th edition showed most diverse stage migration by AJCC 8th edition, and T1a or T2b stage by 7th edition remained in T1-3 or T3-4 by 8th edition. T2 stage by 7th edition showed a significantly higher death rate than the T1 stage, with fair discrimination in overall survival. Higher histologic grade and angiosarcoma were significant prognostic factors for recurrence as well as overall survival. Also, nodal and distant metastasis worsen overall survival. CONCLUSIONS In our series of patients with HNSTS, higher histologic grade, angiosarcoma, N1, and M1 stage significantly increased the risk of recurrence and worse overall survival, which was not evident in revised T stage by AJCC 8th edition.
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Petrovic I, Ahmed ZU, Hay A, Rosen EB, Lu C, Hameed M, Shah JP. Sarcomas of the mandible. J Surg Oncol 2019; 120:109-116. [PMID: 30993699 PMCID: PMC6635012 DOI: 10.1002/jso.25477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Sarcomas of the mandible are extremely rare tumors, with osteosarcoma being the most common, followed by Ewing's sarcoma MATERIALS AND METHODS: A retrospective review of the clinical records, imaging studies, and pathology slides of patients with sarcoma of the mandible at a Tertiary Care Cancer Center from 1998 to 2014 was undertaken. The impact of neoadjuvant chemotherapy and postoperative radiotherapy with or without chemotherapy was studied, and factors impacting upon local control and disease-specific survival were analyzed. RESULTS Twenty-two patients were treated over the study period, comprising of 15 males and seven females. External swelling, intraoral growth, or facial numbness were the presenting symptoms. Eighteen patients had osteosarcoma and four had the Ewing's sarcoma. Nine patients received neoadjuvant chemotherapy. All but one patient underwent surgery. Eleven had negative margins, with 90% recurrence-free survival at 3 years, compared to 10 with positive or close margins, leading to 67% recurrence-free survival. None of the patients receiving neoadjuvant chemotherapy developed recurrence and all were alive at 3 years. The impact of postoperative radiotherapy or adjuvant chemotherapy was not statistically significant. CONCLUSIONS Wide surgical resection with negative margins remains the hallmark of surgical treatment.
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Affiliation(s)
- Ivana Petrovic
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zain U Ahmed
- Department of Surgery, Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashley Hay
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan B Rosen
- Department of Surgery, Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chuanyong Lu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
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Jasper KD, Holloway CL, DeVries KJ, Truong PT. Local Relapse and Survival Outcomes in Patients with Scalp Sarcoma: A Retrospective Study of 95 Patients Treated in a Provincial Cancer Care Institution Over 25 Years. Cureus 2019; 11:e5236. [PMID: 31555498 PMCID: PMC6759421 DOI: 10.7759/cureus.5236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives There is limited literature on the optimal treatment of sarcoma arising in the scalp. This study evaluates local relapse (LR) and survival outcomes of patients with scalp sarcoma treated at a provincial cancer care institution. Methods A retrospective review of 95 patients with a primary diagnosis of scalp sarcoma referred from 1990-2015 was completed. Kaplan-Meier statistics were used to estimate LR-free survival (LRFS) and overall survival (OS). Survival curves were compared using log-rank tests. Regression analyses were performed using Cox proportional hazards model. Results The median age at diagnosis was 77 years. The most common histologies were angiosarcoma (27%), undifferentiated pleomorphic sarcoma (24%), and pleomorphic dermal sarcoma (21%). Final margins were 36% positive, 28% close, 31% negative, and 5% unknown. Of 73 patients treated with curative-intent, 32 (44%) experienced LR. Five-year LRFS was 56.0% and overall survival was 48.3%. Patients with close or positive margins who received pre- or post-operative radiotherapy (n=19) had similar LR risk compared to patients who did not (n=34) (five-year LRFS 41.8% vs 69.1%; p=0.145). On multivariate analysis, angiosarcoma was associated with a higher LR risk (Hazard ratio (HR) 12.06, p<0.001). The use of radiotherapy showed a trend towards reduced LR risk but did not reach statistical significance (HR 0.37, p=0.066). Conclusions Patients with scalp sarcoma have high risk of LR, particularly in cases with positive margins. Adjuvant radiation was not associated with improved local control for close or positive margins. Complete surgical excision to establish negative margins remains the primary standard treatment for patients with this rare disease.
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Affiliation(s)
- Katie D Jasper
- Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, University of British Columbia, Vancouver, CAN
| | - Caroline L Holloway
- Radiation Oncology, British Columbia Cancer Agency, Victoria Centre, University of British Columbia, Victoria, CAN
| | - Kimberly J DeVries
- Population Oncology, Cancer Surveillance & Outcomes, British Columbia Cancer Agency, Vancouver Centre, Vancouver, CAN
| | - Pauline T Truong
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
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Elsayad K, Stockmann D, Channaoui M, Scobioala S, Grajda A, Berssenbrügge H, Huss S, Moustakis C, Haverkamp U, Kleinheinz J, Lenz G, Wardelmann E, Eich HT. Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma. In Vivo 2019; 33:1293-1300. [PMID: 31280221 DOI: 10.21873/invivo.11602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Denise Stockmann
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Mohammed Channaoui
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Sergiu Scobioala
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Aneta Grajda
- Department of Radiation Oncology, Paracelsus Clinic, Osnabruck, Germany
| | - Hendrik Berssenbrügge
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Muenster, Muenster, Germany
| | - Sebastian Huss
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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Yang J, Gao J, Qiu X, Hu J, Hu W, Wu X, Zhang C, Ji T, Kong L, Lu JJ. Intensity-Modulated Proton and Carbon-Ion Radiation Therapy in the Management of Head and Neck Sarcomas. Cancer Med 2019; 8:4574-4586. [PMID: 31231939 PMCID: PMC6712452 DOI: 10.1002/cam4.2319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We report our experience of intensity-modulated proton and carbon-ion radiotherapy (IMPT/IMCT) for head and neck sarcomas (HNS). METHODS AND MATERIALS An analysis of the ongoing prospective data registry from the Shanghai Proton and Heavy Ion Center (SPHIC) for patients with HNS was conducted. The 12- and 24-month rates of local recurrence-free, overall, distant metastasis-free, progression-free survival (LRFS, OS, DMFS, and PFS), and acute/late toxicities were calculated. The prognostic factors for the effectiveness of the treatment were also analyzed. RESULTS Between 7/2014 and 5/2018, 51 consecutive patients with HNS received definitive doses of IMCT (41 cases), IMPT (two cases), or their combination (eight cases). One patient had R0 resection and another treated on the Chinese Food and Drug Administration registration trial received IMPT only. Twenty-seven patients were treated according to various dose escalation trials or institutional protocols using IMCT or IMPT + IMCT boost. Twenty-two patients with locoregional recurrence (10 and four patients failed surgery or surgery followed by radiotherapy, respectively) or radiation-induced second primary sarcomas (eight patients) received salvage particle radiotherapy. With a median follow-up time of 15.7 months, four patients with second primary sarcoma died. The 1- and 2-year OS, PFS, LRFS, and DMFS rates for the entire cohort were 92.9% vs 90%, 73.6% vs 57.4%, 88.4% vs 78.9%, and 84.6% vs 76.5%, respectively. Those rates for patients without prior radiotherapy were 100% vs 100%, 82.1% vs 65.8%, 93.6% vs 85.3%, and 88.4% vs 79.5%, respectively. Multivariate analyses revealed that re-irradiation was an independent prognostic factor for both LRFS and PFS (P = 0.015 and 0.037, respectively). In addition, gross tumor volume (GTV) was an independent prognostic factor for PFS (P = 0.048). One patient experienced Grade 3 acute toxicity (oral mucositis); another experienced Grade 4 acute event (hemorrhage) which required embolization. He lately died from hemorrhage (Grade 5) at 3.4 months after the completion of treatment. No patient experienced radiation-induced acute/late toxicity of ≥ Grade 2 otherwise. CONCLUSION With few observed acute/late toxicities, IMPT/IMCT provided effective short-term tumor control in our patients with HNS. Further investigations, preferably in a prospective fashion, will be required to confirm the efficacy and toxicities of IMPT/IMCT in this group of patients.
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Affiliation(s)
- Jing Yang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jing Gao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Xianxin Qiu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jiyi Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Weixu Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Xiaodong Wu
- Division of Research and Development, SPHIC, Shanghai, China
| | - Chenping Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Stomatology Key Laboratory, Affiliated Ninth People's Hospital, School of Medicine, Shanghai, China
| | - Tong Ji
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Stomatology Key Laboratory, Affiliated Ninth People's Hospital, School of Medicine, Shanghai, China
| | - Lin Kong
- Department of Radiation Oncology, SPHIC, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jiade J Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
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Patient and Tumour Characteristics of Adult Head and Neck Soft Tissue Sarcomas: A Systematic Review and Meta-Analysis. Sarcoma 2019; 2019:9725637. [PMID: 31263380 PMCID: PMC6556341 DOI: 10.1155/2019/9725637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/17/2019] [Accepted: 03/31/2019] [Indexed: 01/09/2023] Open
Abstract
Background Head and neck soft tissue sarcomas (HNSTS) constitute a rare and heterogeneous cancer entity. Management remains a challenge due to the rarity and varied biological behaviour among various subtypes. This systematic review examines the characteristics of tumours and patients with HNSTS. Materials and Methods A systematic literature review and meta-analysis were performed using the electronic databases PubMed and Embase. Eight eligible studies were identified, and 13 variables were extracted from each study including 5-year overall survival (OS) rate and 5-year disease-free survival (DFS) rate. Results We identified eight studies (n = 1,120 patients; 739 males (66%)) from six different countries). In total, 24 histological subtypes were found, and 20% of the sarcomas (n = 215) could not be subclassified. 607 sarcomas (57%) were <5 cm in diameter, and 945 sarcomas (84%) were grade 3. 1,059 patients (90%) underwent surgery. Estimated 5-year OS was 74% (95% CI; 0.63-0.84%) and 5-year DFS was 56% (95% CI; 38-74%). Conclusion HNSTS holds a relative poor prognosis possibly explained by the heterogeneity of the disease. Treatment of HNSTS has shown to be highly diverse, underlining the importance of uniformed treatment guidelines in order to achieve improved survival outcomes.
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Ko E. Primary oral leiomyosarcoma: A systematic review and update. J Oral Pathol Med 2019; 48:780-787. [PMID: 30958581 DOI: 10.1111/jop.12858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
The aim of this systematic review was to address the clinicopathologic inconsistencies noted with primary oral leiomyosarcoma in the literature by amassing the available data published into a comprehensive analysis. Eligibility criteria included publications of cases with dedicated immunohistochemical work-up along with radiographs to evaluate location. Based on these criteria, the systematic review compiled 29 cases. Four primary location sites were identified in the reported cases: soft tissue presentation only, soft tissue with bony involvement, bony involvement only, and bony involvement with a soft tissue component. The majority of primary oral leiomyosarcoma cases reviewed showed a soft tissue predilection, which is in contrast to prior reports of jawbones being the most common site. In addition, there was an improved 5-year survival rate for primary oral leiomyosarcoma limited to the oral cavity and gnathic bones without extension into paranasal sinuses.
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Affiliation(s)
- Eugene Ko
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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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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Andrea T, Giulio G, Giuliana L, Sandro P. Primary dedifferentiated liposarcoma of the orbit, a rare entity: Case report and review of literature. Saudi J Ophthalmol 2019; 33:312-315. [PMID: 31686978 PMCID: PMC6819729 DOI: 10.1016/j.sjopt.2019.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/09/2019] [Indexed: 12/26/2022] Open
Abstract
Head and neck liposarcomas are rare entities accounting for less than 5% of all liposarcomas. The primary orbital location is even rarer, with about 40 cases described in the English literature. According with the widely accepted classification of Enzinger and Weis there are 5 histologic variants of liposarcomas: well differentiated, myxoid, dedifferentiated, round cell and pleomorphic. The first two are considered low-grade and display a favourable prognosis (>90% 5-year DSS and OS), whereas the dedifferentiated, round cell, and pleomorphic are defined high-grade and burdened with poorer prognosis (5-year DSS ranging 45-73%). Dedifferentiated liposarcomas (DDL) of the head and neck region are exceedingly rare, therefore there are scattered and contrasting data regarding their clinical history, treatment modality, and prognosis. We presented a case of DDL arising in the the left orbit (fourth case of primary orbital DDL described), free from disease after 5-year follow-up. Clinical history, treatment, and characteristics of the presented case were described and discussed in the light of how reported in the literature, in the attempt to bring further insight in the nature and management of this rare pathological entity.
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Affiliation(s)
- Torroni Andrea
- Department of Plastic Surgery, Division of Oral and Maxillofacial Surgery, New York University, USA
| | - Gasparini Giulio
- Department of Maxillofacial Surgery, Catholic University of the Sacred Hearth of Rome, Italy
| | - Longo Giuliana
- Department of Maxillofacial Surgery, Catholic University of the Sacred Hearth of Rome, Italy
| | - Pelo Sandro
- Department of Maxillofacial Surgery, Catholic University of the Sacred Hearth of Rome, Italy
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Hamacher R, Kämpfe D, Reuter-Jessen K, Pöttgen C, Podleska LE, Farzaliyev F, Steinau HU, Schuler M, Schildhaus HU, Bauer S. Dramatic Response of a PD-L1-Positive Advanced Angiosarcoma of the Scalp to Pembrolizumab. JCO Precis Oncol 2018; 2:1-7. [PMID: 35135124 DOI: 10.1200/po.17.00107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rainer Hamacher
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Dietrich Kämpfe
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Kirsten Reuter-Jessen
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Christoph Pöttgen
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Lars E Podleska
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Farhad Farzaliyev
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Hans-Ulrich Steinau
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Martin Schuler
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Hans-Ulrich Schildhaus
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
| | - Sebastian Bauer
- Rainer Hamacher, Martin Schuler, Sebastian Bauer, Christoph Pöttgen, Lars E. Podleska, Farhad Farzaliyev, and Hans-Ulrich Steinau, University Hospital Essen, University Duisburg-Essen; Martin Schuler and Sebastian Bauer, German Cancer Consortium, Partner Site University Hospital Essen, Essen; Dietrich Kämpfe, Hematology and Oncology Practice, Lüdenscheid; and Kirsten Reuter-Jessen and Hans-Ulrich Schildhaus, University Hospital Göttingen, Göttingen, Germany
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Sharma N, George NA, Singh R, Iype EM, Varghese BT, Thomas S. Surgical Management of Head and Neck Soft Tissue Sarcoma: 11-Year Experience at a Tertiary Care Centre in South India. Indian J Surg Oncol 2018; 9:187-191. [PMID: 29887699 DOI: 10.1007/s13193-018-0755-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/10/2018] [Indexed: 12/24/2022] Open
Abstract
Head and neck soft tissue sarcoma (HNSTS) is a rare neoplasm accounting for 1% of all head and neck tumours. Because of rarity and varied biological behaviour among various subtypes, knowledge about these tumours is limited. This study aimed at analysing clinicopathological, recurrence and survival pattern of surgically treated HNSTS. Case records of 28 patients of HNSTS who underwent surgery at the Regional Cancer Centre (RCC), Trivandrum (India) between 2002 and 2012 were analysed retrospectively for demographic profile, clinical features, treatment given, recurrence pattern and outcome. The median age of patients was 37 years (range, 3-79) with male:female ratio of 3:2. Majority of patients presented with painless lump in the neck as the most common subsite affected followed by scalp and face. One patient had nodal disease, while none had distant metastasis at presentation. The most frequent histological subtypes were synovial sarcoma and fibrosarcoma followed by malignant fibrous histiocytoma, angiosarcoma and rhabdomyosarcoma. Majority (78.5%) of patients received adjuvant therapy in the form of radiation, chemotherapy or chemo-radiation. After mean follow-up of 49 months, four patients had died, and six developed local recurrence and four distant metastasis. The overall 5-year survival was 82.7% while 5-year disease-free survival was 55.3%. HNSTS is a rare entity that requires multimodality treatment to achieve optimum locoregional control and survival.
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Affiliation(s)
- Nivedita Sharma
- Surgical Oncology Division, Regional Cancer Centre, Trivandrum, 695011 India
| | - Nebu Abraham George
- Surgical Oncology Division, Regional Cancer Centre, Trivandrum, 695011 India
| | - Rajesh Singh
- Surgical Oncology Division, Regional Cancer Centre, Trivandrum, 695011 India
| | | | - Bipin T Varghese
- Surgical Oncology Division, Regional Cancer Centre, Trivandrum, 695011 India
| | - Shaji Thomas
- Surgical Oncology Division, Regional Cancer Centre, Trivandrum, 695011 India
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Abstract
This clinicopathologic study of primary oral leiomyosarcoma of the buccal mucosa involves a literature review of 15 cases with the addition of our report of a case. The demographic details, tumor size, treatment and outcome are documented for all the cases. In addition, this review examines the histologic features of leiomyosarcoma while noting that differentiation from other spindle cell tumors can be challenging, underscoring the necessity of an immunohistochemical work up for an accurate diagnosis. The unpredictability of the clinical behavior of these aggressive tumors requires, at the very least, wide local surgical excision and prolonged follow up.
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Affiliation(s)
- Eugene M. Ko
- 0000000086837370grid.214458.eSchool of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI 48109 USA
| | - Jonathan B. McHugh
- 0000000086837370grid.214458.eDepartment of Pathology, University of Michigan, Ann Arbor, MI USA
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Cante D, Franco P, Sciacero P, Girelli GF, Borca VC, Pasquino M, Tofani S, Bombaci S, Migliaccio F, Marra A, Numico G, La Porta MR, Ricardi U. Combined chemoradiation for head and neck region myxofibrosarcoma of the maxillary sinus. TUMORI JOURNAL 2018; 99:e80-3. [DOI: 10.1177/030089161309900235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Adult sarcomas of the head and neck region (HNSs) are considered a rare clinicopathological entity. They account for only 2–15% of all adult sarcomas and for less than 1% of all head and neck malignancies. The preferred initial treatment option is wide surgical excision. Whenever surgery is considered infeasible, a frontline combined-modality approach including radiotherapy and chemotherapy might be proposed. We here report on a case of localized sarcoma of the maxillary sinus treated with induction chemotherapy and subsequent intensity-modulated radiation therapy (IMRT), achieving a persistent complete remission status. Methods A 66-year-old man was referred to our institution hospital for left-sided facial pain with swollen left cheek and ipsilateral facial palsy. Magnetic resonance imaging showed a mass within the left maxillary sinus extending to the orbital floor and adjacent alveolar bones. Histological examination of the biopsy specimen demonstrated a myxofibrosarcoma. The patient underwent induction chemotherapy with gemcitabine 900 mg/m2 (days 1–8) and taxotere 80 mg/m2 every 3 weeks for 3 cycles and sequential simultaneous integrated boost (SIB) IMRT up to a total dose of 70 Gy/35 fractions to the macroscopic disease with 59.5 Gy/35 fractions to the level IB-II lymph nodes in the left neck. Results Treatment was well tolerated with mild acute toxicity. Complete remission was achieved at restaging MRI 6 months after the end of the combined modality approach. The patient remains in complete, unmaintained clinical and instrumental complete remission 18 months after treatment, with no late side effects. Conclusion Combination therapy with induction chemotherapy and sequential SIB-IMRT could therefore be a promising modality for head and neck sarcomas, allowing for simultaneous tumor control and normal tissue sparing.
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Affiliation(s)
- Domenico Cante
- Department of Radiation Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea
| | - Pierfrancesco Franco
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale U Parini, AUSL Valle d'Aosta, Aosta
| | - Piera Sciacero
- Department of Radiation Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea
| | | | | | - Massimo Pasquino
- Department of Medical Physics, ASL TO4, Ospedale Civile di Ivrea, Ivrea
| | - Santi Tofani
- Department of Medical Physics, ASL TO4, Ospedale Civile di Ivrea, Ivrea
| | - Sebastiano Bombaci
- Department of Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea
| | - Fernanda Migliaccio
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale U Parini, AUSL Valle d'Aosta, Aosta
| | - Annamaria Marra
- Department of Radiation Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea
| | - Gianmauro Numico
- Medical Oncology Department, Ospedale Regionale U Parini, AUSL Valle d'Aosta, Aosta
| | | | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, Ospedale San Giovanni Battista, Turin, Italy
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Viviano M, Miracco C, Lorenzini G, Baldino G, Cocca S. Gingival Leiomyosarcoma in a Young Woman: Case report and literature review. Sultan Qaboos Univ Med J 2018; 17:e472-e476. [PMID: 29372093 DOI: 10.18295/squmj.2017.17.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/23/2017] [Accepted: 11/23/2017] [Indexed: 01/13/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare mesenchymal malignancy, of which 3-10% of cases occur in the head and neck region. We report a 22-year-old woman who was referred to the University Hospital of Siena, Italy, in 2016 with an ostensibly benign asymptomatic lump on the mandibular gingiva. The lesion grew rapidly, causing otalgia in the right ear. An excisional biopsy was performed and primary LMS was diagnosed histologically. Subsequently, the patient underwent radical re-excision of the perilesional mucosa, a partial bone resection and the extraction of four teeth. No recurrences or metastases were detectable at a 20-month follow-up. This report discusses the differential diagnosis of LMS with regards to other benign and malignant lesions and reviews the recent literature on primary and secondary oral LMS. Due to its innocuous clinical features-including its asymptomatic nature and presentation at a young age-this aggressive malignancy can go undetected; therefore, an early histopathological diagnosis is crucial.
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Affiliation(s)
- Massimo Viviano
- Department of Dentistry & Ophthalmology, University of Siena, Siena, Italy
| | - Clelia Miracco
- Department of Pathological Anatomy, University of Siena, Siena, Italy
| | - Guido Lorenzini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Gennaro Baldino
- Department of Pathological Anatomy, University of Siena, Siena, Italy
| | - Serena Cocca
- Department of Ear, Nose & Throat, University of Siena, Siena, Italy
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Undifferentiated pleomorphic sarcoma of the neck - A case report. Int J Surg Case Rep 2017; 41:43-46. [PMID: 29031178 PMCID: PMC5645475 DOI: 10.1016/j.ijscr.2017.09.020] [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: 09/11/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/10/2022] Open
Abstract
Undifferentiated pleomorphic sarcoma very rarely affect the neck. We report a case of a 62year old man who presented with a right sided skin lump which he noticed after sustaining a neck contusion in a road traffic accident about one year ago. The initial CT and ultrasound scans of the lump were suggestive of a thrombosed varix. Clinical examination showed a hard skin nodule with signs of tethering. He underwent a wide excision of the skin nodule and the histology showed undifferentiated pleomorphic sarcoma with margins involved. He subsequently underwent another re-excision of margins and pectoralis major flap reconstruction. Following surgery, he was also prescribed adjuvant radiotherapy and he remains well about 12 months after follow up. The surgical management of undifferentiated pleomorphic sarcoma in the neck is challenging due to the proximity of critical neck structures and the need to obtain clear margins. Thus, adjuvant radiotherapy is often used to improve disease control.
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Cabral ANF, Rocha RH, Amaral ACVD, Medeiros KB, Nogueira PSE, Diniz LM. Cutaneous angiosarcoma: report of three different and typical cases admitted in a unique dermatology clinic. An Bras Dermatol 2017; 92:235-238. [PMID: 28538886 PMCID: PMC5429112 DOI: 10.1590/abd1806-4841.20175326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/22/2016] [Indexed: 12/24/2022] Open
Abstract
Angiosarcoma is a rare and aggressive tumor with high rates of metastasis and
relapse. It shows a particular predilection for the skin and superficial soft
tissues. We report three distinct and typical cases of angiosarcoma that were
diagnosed in a single dermatology clinic over the course of less than a year: i)
Angiosarcoma in lower limb affected by chronic lymphedema, featuring
Stewart-Treves syndrome; ii) a case of the most common type of angiosarcoma
loated in the scalp and face of elderly man and; iii) a skin Angiosarcoma in
previously irradiated breast. All lesions presented characteristic
histopathological findings: irregular vascular proliferation that dissects the
collagen bundles with atypical endothelial nuclei projection toward the
lumen.
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Affiliation(s)
- Aline Neves Freitas Cabral
- Hospital Universitário Cassiano Antônio Moraes, da Universidade Federal do Espírito Santo (Hucam-Ufes) - Vitória (ES), Brazil
| | - Rafael Henrique Rocha
- Hospital Universitário Cassiano Antônio Moraes, da Universidade Federal do Espírito Santo (Hucam-Ufes) - Vitória (ES), Brazil
| | - Ana Cristina Vervloet do Amaral
- Hospital Universitário Cassiano Antônio Moraes, da Universidade Federal do Espírito Santo (Hucam-Ufes) - Vitória (ES), Brazil
| | - Karina Bittencourt Medeiros
- Professional Master´s Programa in Medicine of the Universidade Federal do Espírito Santo (Ufes) - Vitória (ES), Brazil
| | - Paulo Sérgio Emerich Nogueira
- Hospital Universitário Cassiano Antônio Moraes, da Universidade Federal do Espírito Santo (Hucam-Ufes) - Vitória (ES), Brazil
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American Brachytherapy Society consensus statement for soft tissue sarcoma brachytherapy. Brachytherapy 2017; 16:466-489. [DOI: 10.1016/j.brachy.2017.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
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46
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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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Abstract
Focal myositis is a rare benign inflammatory pseudotumor that can mimic malignancy, clinically and on imaging. A 34-year-old man presented with a 3-week history of sudden-onset, nontender, left upper neck mass that was nonresolving with antibiotics. Anatomical imaging was concerning for a sarcoma of the sternocleidomastoid muscle with possible regional nodal metastases and surrounding inflammatory change. F-FDG PET/CT showed marked FDG uptake extending around the anterior border of the sternocleidomastoid muscle with no FDG-avid local nodal disease. Core biopsy of the sternocleidomastoid muscle and adjacent node revealed inflammatory changes. A diagnosis of focal inflammatory myositis was made.
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The First Ever Reported Case of Primary Synovial Sarcoma of Scalp. Case Rep Surg 2016; 2016:5358790. [PMID: 27446625 PMCID: PMC4942655 DOI: 10.1155/2016/5358790] [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: 01/27/2016] [Revised: 06/05/2016] [Accepted: 06/13/2016] [Indexed: 11/18/2022] Open
Abstract
Synovial sarcomas are a rare entity with predilection for extremities and joints. The literature suggests that these tumours are rare in the head and neck region. Very few authors have reported their origin in head. Among the ones occurring in the head region, most of them are found to originate from the parotid area. According to our extensive review of available literature, there has been no reported case of the primary case of synovial sarcoma originating from the scalp convexity. We hereby report one such case in a young female which, by far to the best of our knowledge, is the first ever reported case of a synovial sarcoma occurring on the scalp. The tumour is also the largest ever reported in the literature and posed a great surgical and diagnostic challenge to our team. Through this paper, we recommend that synovial sarcoma should be included as a very rare yet possible differential diagnosis for the scalp tumours.
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A nation-wide epidemiological study on the risk of developing second malignancies in patients with different histological subtypes of nasopharyngeal carcinoma. Oral Oncol 2016; 56:40-6. [DOI: 10.1016/j.oraloncology.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/01/2016] [Accepted: 02/18/2016] [Indexed: 11/24/2022]
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Novel PAX3-NCOA1 Fusions in Biphenotypic Sinonasal Sarcoma With Focal Rhabdomyoblastic Differentiation. Am J Surg Pathol 2016; 40:51-9. [PMID: 26371783 DOI: 10.1097/pas.0000000000000492] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sarcomas arising in the sinonasal region are uncommon and encompass a wide variety of tumor types, including the newly described biphenotypic sinonasal sarcoma (BSNS), which is characterized by a monomorphic spindle cell proliferation with dual neural and myogenic phenotypes. Most BSNSs harbor a pathognomonic PAX3-MAML3 fusion driven by t(2;4)(q35;q31.1), whereas the alternative fusion partner gene remains unidentified in a subset of PAX3-rearranged cases. As NCOA1 on 2p23 is a known partner in PAX3-related fusions in other tumor types (ie, alveolar rhabdomyosarcoma), we investigated its status by fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction assays in 2 BSNS cases showing only PAX3 gene rearrangements. Novel PAX3-NCOA1 fusions were identified in these 2 index cases showing an inv(2)(q35p23) by FISH and confirmed by reverse transcription polymerase chain reaction. Five additional BSNS cases with typical morphology were studied by FISH, revealing a PAX3-MAML3 fusion in 4 cases and only PAX3 rearrangement in the remaining case without abnormalities in MAML3 or NCOA1 gene. Except for 1 case with surface ulceration, all other tumors lacked increased mitotic activity or necrosis, and all cases immunohistochemically coexpressed S100 protein and actin, but lacked SOX10 reactivity. Interestingly, the 2 PAX3-NCOA1-positive cases showed desmin reactivity and displayed a small component of rhabdomyoblastic cells, which were not seen in the more common PAX3-MAML3 fusion cases. In conclusion, we report a novel PAX3-NCOA1 fusion in BSNS, which appears to be associated with focal rhabdomyoblastic differentiation and should be distinguished from PAX3-NCOA1-positive alveolar rhabdomyosarcoma or malignant Triton tumor. SOX10 immunohistochemistry is a useful marker in distinguishing BSNS from peripheral nerve sheath tumors.
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