Abstract
Purpose
To profile the clinical presentation, subtype distribution, and treatment results of sarcomas of the head and neck at a single tertiary academic center over an 11-year period.
Materials and methods
A retrospective review was performed by examining the records and reviewing the pathology of 186 patients with head and neck sarcomas treated at UCLA Medical Center from 2000 to 2011.
Results
The mean age of the study population was 49 ± 22 years. 58% of the patients were male and 42% were female. Median duration of follow-up for the entire group was 18.5 months. The most common presenting symptom was a mass lesion in 59.9% of patients. The nasal cavity/sinus was the most common presenting site seen in 22% of patients. Solitary fibrous tumor/hemangiopericytoma was the most common subtype. 15% of patients had evidence of prior radiation exposure. 26.3% of tumors were greater than 5 cm and 35.5% were high-grade. Margins were positive in 31.2% of patients. Lymph node metastasis was rare at 6.5%. Perineural invasion was identified in 6.5%. Among all subtypes, 5-year recurrence-free survival and overall survival were 50% and 49%, respectively. Multivariate analysis demonstrated that grade and margin status were predictors of recurrence-free survival while grade and age affected overall survival.
Conclusions
Head and neck sarcomas are a rare entity frequently presenting as a mass lesion. In our series, lesions tended to be high-grade with a significant portion of surgical specimens having positive margins. Grade and margin status were the most important predictors of survival.
1
Introduction
The management of sarcomas of the head and neck remains a challenge in the field of head and neck oncology. As sarcomas comprise less than 1% of all head and neck malignancies , there are no prospective, randomized-controlled trials to guide management. Current guidelines are based on the collective efforts of retrospective studies from tertiary-care centers as well as treatment guidelines extrapolated from sarcomas of the trunk and extremities.
Sarcomas are malignancies that arise from transformed cells of mesenchymal origin. Current classification schemes attempt to group sarcomas into subtypes that are useful for determining prognosis and formulating treatment strategies. In general, these neoplasms are grouped by mesenchymal cell of origin, head and neck subsite and histologic grade. The vast majority of tumors, approximately 80%, are of soft-tissue origin while the remaining 20% are of bony or cartilaginous origin . Due to the multitude of tissue types, sarcomas are a heterogenous group of malignancies whose histologic characteristics reflect their tissue of origin. Histologic grade is a consistent predictor of prognosis and its importance is illustrated in the AJCC staging system for sarcomas . Difficulty can arise in formulating a standardized treatment algorithm for sarcomas, as there are often inconsistencies in pathologic evaluations both from a histologic and grading standpoint. This inconsistency often makes it difficult to pool multi-institutional studies.
Here, we profile the clinical presentation, subtype distribution, and treatment results of 186 patients with sarcomas of the head and neck at a single tertiary academic center. The resulting group of patients was analyzed by multivariate analysis to define specific prognostic features that predict outcome and guide treatment approaches. Furthermore, careful subgroup analyses were performed to identify trends and sarcoma subtypes of distinct biologic behavior.
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