Head and neck sarcomas-clinicopathological findings, treatment modalities and its outcome - A retrospective study

Epidemiological Study of Head and Neck Sarcomas

Introduction

Head and neck sarcomas are uncommon tumors that account for less than 1% of head and neck malignancies and fewer than 5% of all sarcomas. This study aims to assess the head and neck sarcomas pattern in Isfahan, Iran, compare its results with previous findings, and investigate treatment methods and the recurrence and survival rate.

Materials and Methods

This study was done on 160 patients diagnosed with head and neck sarcomas between 2001 and 2020 in four medical centers in Isfahan, Iran. The patients with head and neck sarcoma confirmed by biopsy were included. Patient information included sex, age at diagnosis, and full characteristics of the mass. Disease recurrence and 2-year and 5-year overall survival (OS) were investigated by phone.

Results

Among 160 patients, 94 (58.8%) were male. The mean age was 36.9 ± 23.2 years. The neck was the most reported location for sarcomas (N=34, 21.3%). Undifferentiated pleomorphic sarcoma was the most frequent histopathologic pattern (N=48, 30.0%). The brain and lungs were the most common destinations for metastasis. "Surgery and adjuvant therapy together" was the most common type of treatment (N=108, 68.8%). The 2-year and 5-year recurrence rates were N=100, 62.5%, and N=110, 68.8%, respectively. The 2-year and 5-year OS was N=103, 64.4%, and N=58, 36.6%, respectively. Eighty-nine patients have had metastasis (55.6%).

Conclusions

Both 2-year and 5-year recurrence rates and OS were significantly correlated with metastasis. The OS within two years and five years were significantly higher in those treated only by "Surgery".

Head and Neck Low Grade Chondrosarcoma-A Rare Entity

Chondrosarcoma represents approximately 0.1% of all neoplasms of the head and neck and is considered a rare disease with a relatively good prognosis. The 5-year overall survival (OS) rate is estimated at 70-80%, being considered a disease with a low growth rate. Approximately 13% of all cases of chondrosarcoma are located in the region of the head and neck. We present the case of a 30-year-old patient without a medical history who reported dysphagia, swallowing difficulty, neck mass sensation and dysphonia that started insidiously after an upper respiratory tract infection. Subsequently, the patient was diagnosed with a low-grade glosso-epiglottic region chondrosarcoma and was multimodally treated with surgery followed by chemotherapy and radiotherapy. The radiation treatment was delivered with a Rokus M40 former Soviet Union cobalt machine without any image guidance capabilities. The inability to obtain resection margin information justified an aggressive adjuvant treatment with chemotherapy and radiotherapy. The early loss from the oncological record without recurrence of the disease could be associated in this case with the consequence of a major complication, of which we could assume an aspiration pneumonia secondary to a dysphagia associated with an aggressive multidisciplinary treatment. Large tumor size and positive resection margins (R1 resection) are risk factors that support an intensive adjuvant approach in order to reduce the risk of recurrence, but the low grade of tumor associated with a lower risk of recurrence as well as the adverse events (AE) of adjuvant radiotherapy and chemotherapy justify a more reserved therapeutic approach. Taking into account the longer life expectancy of these patients, it is recommended to use a more conformal irradiation technique in order to reduce doses to radiosensitive structures as well as to omit elective neck irradiation, taking into account the lower risk of lymph node involvement. The lack of guidelines, which include very rare tumors including low grade chondrosarcoma of the head and neck, makes a unified approach difficult, but the data presented in case reports could contribute to choosing the regimen that offers the best therapeutic ratio.