Adult soft tissue sarcomas of the head and neck treated by radiation and surgery or radiation alone: Patterns of failure and prognostic factors

Henning Willers, Eugen B. Hug, Ira J. Spiro, Jimmy T. Efird, Andrew E. Rosenberg, C. C. Wang

Research output: Contribution to journalArticle

70 Scopus citations

Abstract

Purpose: To analyze our experience treating soft tissue sarcomas of the head and neck in adults, and to identify patterns of failure and prognostic factors. Methods and Materials: The recors of 57 patients with Stage M0 disease treated by radiation with or without surgery between 1972 and 1993 were reviewed. Medial follow-up time was 4.3 years (range, 1.1-16.8 years). A group of potential prognostic factors was evaluated, including age diagnosis, sex, initial tumor presentation (primary vs. recurrent), grade, T-stage, direct tumor extension, tumor depth, duration of treatment, and radiation dose. Results: The subset of angiosarcomas (11 of 57 patients) had a considerably adverse effect on treatment outcome for the total group of sarcomas, with actuarial 5-year overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FDM) rates being 31%, 24%, and 42%, respectively. In contrast, for the remaining 46 patients with other histopathological tumor types, OS, LRC, and FDM rates were significantly higher (74%, 69%, and 83%, respectively). For this group of patients, significant prognostic factors identified by uni- and multivariate analysis included tumor grade as a predictor of OS and T-stage 3s a predictor of LRC (p ≤ 0.050). Those patients who experienced a locoregional recurrence were at a significantly increased risk of dying (p = 0.004 in a multivariate model). All 17 patients withou direct tumor extension to neurovascular structures, bone, contiguous organs, or skin remained free from distant failure. In contrast, 27% of 29 patients with direct extension had developed distant metastases at 5 years. In multivariate analysis, the absence of direct extension was a positive predictor of FDM (p = 0.007) and of OS (p = 0.034). Conclusions: 1) Angiosarcomas of the head and neck have a considerably poorer prognosis than other soft tissue sarcomas of this site. 2) In addition to tumor grade and size, direct tumor extension may be a useful additional staging parameter. 3) High rates of locoregional failure in the head and neck area, a potential cause of morbidity and death, indicate a need for improved treatment strategies.

Original languageEnglish (US)
Pages (from-to)585-593
Number of pages9
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume33
Issue number3
DOIs
StatePublished - Oct 15 1995
Externally publishedYes

Keywords

  • Angiosarcoma
  • Head and neck
  • Local control
  • Prognostic factors
  • Soft tissue sarcoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

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