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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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Huang Z, Yu X, Yan J, Yin Y, Li J, Zheng Y. Primary leiomyosarcoma of the thyroid gland: A rare case report and literature review. Int J Surg Case Rep 2024; 119:109773. [PMID: 38772244 PMCID: PMC11128507 DOI: 10.1016/j.ijscr.2024.109773] [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: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Primary thyroid leiomyosarcoma is an extremely rare soft tissue sarcoma, characterized by high malignancy and poor prognosis. Currently, only 13 cases of primary thyroid leiomyosarcoma have been described in the medical literature (limited to English). CASE PRESENTATION A 76-year-old female presented with a giant neck mass. Physical examination revealed a large, firm mass in the left thyroid gland. No symptoms such as hoarseness or dysphagia were noted at the time of presentation. The patient underwent unilateral thyroidectomy and cervical lymph node dissection. CLINICAL DISCUSSION Pathologic findings revealed a low-grade sarcoma with spindle-shaped tumor cells in an interwoven, sheet-like distribution. Immunohistochemistry showed positivity for desmin, SMMHC, STAT6, CK19, and Galectin3, but negativity for S-100, MyoD1, CD34, CK (AE1/AE3), CD117, and CD56. The findings were consistent with thyroid leiomyosarcoma. CONCLUSION The treatment of primary thyroid LMS presents challenges due to its atypical symptoms and high malignance, highlighting the imperative for further exploration of therapeutic strategies to improve the outcomes.
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Affiliation(s)
- Ziwei Huang
- Department of General Surgery, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China
| | - Xiping Yu
- Department of Pathology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China
| | - Jialang Yan
- Department of General Surgery, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China
| | - Yuanxiao Yin
- Department of General Surgery, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China
| | - Junhao Li
- Department of General Surgery, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China
| | - Yixiong Zheng
- Department of General Surgery, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu 322000, China.
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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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Tan Z, Liu J, Xue R, Fan Z, Bai C, Li S, Gao T, Zhang L, Wang X. Clinical features and therapeutic outcomes of alveolar soft part sarcoma in children: A single-center, retrospective study. Front Oncol 2022; 12:1019911. [PMID: 36505873 PMCID: PMC9730233 DOI: 10.3389/fonc.2022.1019911] [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: 08/15/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is a rare sarcoma that has been shown to be highly effective to antiangiogenic agents and immune checkpoint inhibitors, but most reported studies about ASPS were concentrated on adult population. In this study, we aimed to describe the clinical features and therapeutic outcomes of ASPS in children. Methods We retrospectively reviewed the records of patients with ASPS in our institution since Jan 2015. All patients included in this study were pathologically confirmed ASPS and aged under 12 years at the time of initial diagnosis. Demographic characteristics, tumor sizes, primary tumor sites, metastasis, treatments used, therapeutic responses and survivals were evaluated. Results We identified a total of 56 patients to be initially diagnosed as ASPS since Jan 2015. A predisposition of high occurrence in head and neck (32.1%) was observed (versus 41.1% in limbs and 21.4% in trunk). 26 (46.4%) patients developed metastasis at the time of diagnosis or during follow-up. Tumors in tongue, pharynx and larynx had the least likelihood to metastasize (7.7%, P<0.05). Observation was recommended for 15 stage IV patients with only pulmonary metastasis. 7 (46.7%) patients remained stable until last follow up. The 1-year PFS rate was 83.3% and median progression-free survival time (PFS) was 29.4 months. 15 patients with progressive disease received mono or combined therapy. 11 patients received PD-1 monotherapy. 2 patients achieved partial response and 5 stable disease. The overall response rate was 18.2%. The median PFS of this group was 22.0 months, and the 1-year PFS rate was 70.0%. 4 patients received a combination therapy of PD-1 inhibitors plus tyrosine kinase inhibitors. All of them remained stable. No disease-related death occurred during follow-up. Conclusions ASPS exhibits a higher occurrence in head and neck in children. ASPS originating from glossopharyngeal region tends to have a lower metastasis rate. ASPS displays a more indolent growth pattern in children, which makes observation a preferable choice for children with sole pulmonary metastasis. Pediatric ASPS appears to be less effective to targeted therapy and immunotherapy than adults. The treatment of progressive ASPS in children remains challenging.
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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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Sawhney R, Ahsanuddin S, Sheorey L, Wassef DW, Baredes S, Park RCW. Understanding giant cell sarcoma of the head and neck: A population-based study. Head Neck 2021; 43:2786-2794. [PMID: 34121252 DOI: 10.1002/hed.26765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/24/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant cell sarcomas (GCS) are rare head and neck neoplasms. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for all patients who have been diagnosed with GCS from 1973 to 2014. RESULTS Four hundred and forty cases of GCS of the head and neck were identified. The average age at diagnosis was 74.4 years, 86.8% were white, 82.5% were male, 70.7% were insured, and 88.2% lived in an urban metropolitan region. Connective tissue was the most frequent primary site (42.5%). The 5Y-DSS rate was 91.1%, while the 5Y-OS was 54.6% for all cases. Patients treated with surgery alone had the highest 5Y-DSS rate of 94.5. T-classification odds ratio was a significant predictor of survival accounting for confounding variables on multivariate analysis. CONCLUSIONS GCS presents most frequently in connective tissue of the head and neck with overall high probability of survival. The treatment of choice is surgery alone.
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Affiliation(s)
- Rohan Sawhney
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Salma Ahsanuddin
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lena Sheorey
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David W Wassef
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Reichel CA. Rare Diseases of the Oral Cavity, Neck, and Pharynx. Laryngorhinootologie 2021; 100:S1-S24. [PMID: 34352905 PMCID: PMC8432966 DOI: 10.1055/a-1331-2851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diseases occurring with an incidence of less than 1-10 cases per 10 000 individuals are considered as rare. Currently, between 5 000 and 8 000 rare or orphan diseases are known, every year about 250 rare diseases are newly described. Many of those pathologies concern the head and neck area. In many cases, a long time is required to diagnose an orphan disease. The lives of patients who are affected by those diseases are often determined by medical consultations and inpatient stays. Most orphan diseases are of genetic origin and cannot be cured despite medical progress. However, during the last years, the perception of and the knowledge about rare diseases has increased also due to the fact that publicly available databases have been created and self-help groups have been established which foster the autonomy of affected people. Only recently, innovative technical progress in the field of biogenetics allows individually characterizing the genetic origin of rare diseases in single patients. Based on this, it should be possible in the near future to elaborate tailored treatment concepts for patients suffering from rare diseases in the sense of translational and personalized medicine. This article deals with orphan diseases of the lip, oral cavity, pharynx, and cervical soft tissues depicting these developments. The readers will be provided with a compact overview about selected diseases of these anatomical regions. References to further information for medical staff and affected patients support deeper knowledge and lead to the current state of knowledge in this highly dynamic field.
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Affiliation(s)
- Christoph A Reichel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, KUM-Klinikum, Ludwig-Maximilians-Universität München, München
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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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Akagündüz B, Akin Telli T, Sezgin Goksu S, Yildirim HC, Ozer M, Göktaş Aydin S, Ozyurt N, Karacin C, Paydas S, Dogan M. Assessment of Prognostic Factors and Adjuvant Treatment Modalities in Adult Head and Neck Soft Tissue Sarcoma Patients Treated With Upfront Surgery. Cureus 2021; 13:e13324. [PMID: 33738167 PMCID: PMC7958307 DOI: 10.7759/cureus.13324] [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] [Indexed: 11/23/2022] Open
Abstract
Objectives Head and neck soft tissue sarcomas (HNSTSs) are a heterogeneous group of rare tumors. Surgical resection with negative margins remains the standard primary treatment for patients with HNSTS. The role of chemotherapy (CT) and radiotherapy (RT) remains controversial. In this multicenter study, we aimed to demonstrate the real-world assessing prognostic factors and the effect of adjuvant treatment modalities in adult patients with HNSTS treated with upfront surgery. Methods We included a total of 47 patients who underwent curative-intent resection of a primary HNSTS between 2000 and 2019. Results The median follow-up was 29 months. The median age of patients was 51 years, and 66% of patients were male. The median relapse-free survival (RFS) of the study population was 31 months (range: 1.0-61.1 months), and the median overall survival (OS) was 115 months (range: 60.8-169.2 months). The univariable analysis revealed that treatment modalities showed a significant impact on RFS (p = 0.021); however, no difference was found in its impact on OS (p = 0.137). R0 resection did not showed impact on RFS (p = 0.130), but a significant association was found with OS (p = 0.004). In multivariable analysis, T stage of the tumor (hazard ratio [HR]: 3.834; 95% CI: 1.631-9.008; p = 0.002) and treatment with surgery and sequential RT and CT (HR: 0.115; 95% CI: 0.035-0.371; p < 0.001) were independent factors associated with RFS. R0 resection was independently associated with OS (HR: 4.902; 95% CI: 1.301-18.465; p = 0.019). Conclusion Our study revealed that R0 resection improved OS, and T3-4 stage of tumor was a negative independent factor for RFS in surgically resected HNSTS patients. The use of sequential CT and RT after resection was associated with a better RFS, which emphasizes the importance of multidisciplinary evaluation of the treatment of HNSTS. Randomized prospective studies are needed
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Affiliation(s)
- Baran Akagündüz
- Medical Oncology, Erzincan Binali Yıldırım Üniversitesi Mengücek Gazi Hastanesi, Erzincan, TUR
| | - Tugba Akin Telli
- Medical Oncology, Marmara University Medical School, Istanbul, TUR
| | | | | | - Muhammet Ozer
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | | | | | - Cengiz Karacin
- Oncology, Recep Tayyip Erdoğan University Medical School, Rize, TUR
| | - Semra Paydas
- Medical Oncology, Cukurova University Faculty of Medicine, Adana, TUR
| | - Mutlu Dogan
- Medical Oncology, Ankara Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR
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Ram H, Kumar S, Singh SN, Kumar P, Singh G, Ganguly R, Sagar M, Howlader D. Head and neck sarcomas-clinicopathological findings, treatment modalities and its outcome - A retrospective study. Ann Maxillofac Surg 2021; 11:280-286. [PMID: 35265499 PMCID: PMC8848714 DOI: 10.4103/ams.ams_366_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
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Radiation Therapy in Adult Soft Tissue Sarcoma-Current Knowledge and Future Directions: A Review and Expert Opinion. Cancers (Basel) 2020; 12:cancers12113242. [PMID: 33153100 PMCID: PMC7693687 DOI: 10.3390/cancers12113242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment and is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS. Abstract Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.
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Recurrent pleomorphic dermal sarcoma of the temporal bone: Case report and literature review. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Torabi SJ, Bourdillon A, Salehi PP, Kafle S, Mehra S, Rahmati R, Judson BL. The epidemiology, surgical management, and impact of margins in skull and mandibular osseous-site tumors. Head Neck 2020; 42:3352-3363. [PMID: 32743892 DOI: 10.1002/hed.26389] [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: 11/18/2019] [Revised: 04/14/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors. METHODS Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016). RESULTS Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]). CONCLUSION Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.
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Affiliation(s)
- Sina J Torabi
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alexandra Bourdillon
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samipya Kafle
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Rahmatullah Rahmati
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
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14
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Characterization of alveolar soft part sarcoma using a large national database. Surgery 2020; 168:825-830. [PMID: 32703677 DOI: 10.1016/j.surg.2020.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alveolar soft part sarcoma is a rare, histologic subtype of soft tissue sarcoma that remains poorly defined. We aimed to describe patient characteristics and treatment patterns and to examine factors associated with survival for patients with alveolar soft part sarcoma. METHODS After identifying patients with alveolar soft part sarcoma in the National Cancer Database, we recorded their clinicopathologic characteristics. Univariable log-rank survival analysis and Cox proportional hazards model were employed. For context, survival comparisons were included for patients with other sarcoma subtypes. RESULTS Overall, 293 patients with alveolar soft part sarcoma were identified. Interestingly, patients with head and neck tumors were least likely to present with distant disease (40%, P = .025). The majority of patients underwent resection (n = 183, 63%). Among those, no predictors of lesser survival were identified other than the presence of metastases (hazard ratio 6.04, P ≤ .001). Patients with stage IV alveolar soft part sarcoma who underwent resections experienced improved survival relative to similar patients with more common subtypes of soft tissue sarcomas (P ≤ .001). CONCLUSION Alveolar soft part sarcoma is exceedingly rare, and patients often present with metastases. Primary tumors can occur anywhere in the body, and location impacts the rates of metastases at presentation. Resection is associated with a favorable survival advantage when compared to other, more common histologic subtypes of soft tissue sarcomas.
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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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Kang Y, Bae J, Choi S, Jang KT, Yu J, Hong JY, Lim SY, Jeong HS. Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases. Ann Surg Oncol 2020; 27:3018-3027. [PMID: 32458324 DOI: 10.1245/s10434-020-08408-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas. METHODS This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner. RESULTS The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes. CONCLUSIONS For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.
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Affiliation(s)
- Yungjee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juyoung Bae
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeongil Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yong Hong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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17
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Hameed M, Horvai AE, Jordan RCK. Soft Tissue Special Issue: Gnathic Fibro-Osseous Lesions and Osteosarcoma. Head Neck Pathol 2020; 14:70-82. [PMID: 31950477 PMCID: PMC7021863 DOI: 10.1007/s12105-019-01094-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
Abstract
Gnathic fibro-osseous lesions are a diverse group of disease processes which share overlapping microscopic features characterized by fibroblastic stroma with variable cellularity and a range of bone forming pathological processes leading to woven, sclerotic and cementum-like structures. Some of the lesions are unique to craniofacial location and a combination of clinical, radiological and pathological correlation is often necessary for diagnostic accuracy. Gnathic osteosarcomas are rare tumors with differences in age distribution and behavior as compared to osteosarcoma of long bones. This review will discuss the clinicopathological and radiological features of gnathic fibro-osseous lesions and osteosarcoma with updates on current genetics and molecular pathogenesis.
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Affiliation(s)
- Meera Hameed
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
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18
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Hypofractionated radiotherapy for non-metastatic bone and soft tissue sarcomas. Cancer Radiother 2019; 23:853-859. [PMID: 31640927 DOI: 10.1016/j.canrad.2019.06.011] [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: 04/04/2019] [Revised: 06/01/2019] [Accepted: 06/10/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the efficacy and toxicity of hypofractionated radiotherapy in non-metastatic soft tissue and bone sarcomas. PATIENTS AND METHODS Thirty patients underwent hypofractionated radiotherapy between 2007 and 2015. Overall, 17 patients underwent primary hypofractionated radiotherapy, nine underwent hypofractionated radiotherapy for reirradiation, and four received a boost dose via hypofractionated radiotherapy after external beam radiotherapy. Most common disease sites were head and neck and retroperitoneum. Hypofractionated radiotherapy was administered with a definitive, adjuvant, or neoadjuvant intent. RESULTS Median age was 37 years (range: 11-82 years). Median hypofractionated radiotherapy dose was 35Gy (range: 20-50Gy) in three to five fractions. Median follow-up was 21 months (range: 1-108 months). One- and 2-year overall survival rate was 75% and 52%, respectively. One- and 2-year local recurrence-free survival rate was 59% and 48%, with local recurrence rates of 16% and 33% in 1 and 2 years, respectively. Univariate analysis revealed tumour size (P=0.04), hypofractionated radiotherapy intent (P=0.016) and reirradiation (P=0.001) as prognostic factors for local recurrence-free survival. Severe late toxicity was observed in one patient as grade 3 trismus. CONCLUSION Hypofractionated radiotherapy as the primary treatment or for reirradiation has been shown to be safe in the treatment of bone and soft tissue sarcomas. It can provide relatively good local control and survival rates.
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19
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Clinical characteristics associated with primary cardiac angiosarcoma outcomes: a surveillance, epidemiology and end result analysis. Eur J Med Res 2019; 24:29. [PMID: 31426842 PMCID: PMC6699122 DOI: 10.1186/s40001-019-0389-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 08/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCAS) is a rare type of tumour. Furthermore, descriptions of the demographic features and prognostic factors of PCAS patients have been poorly reported. METHODS A population cohort study was conducted using retrospectively extracted data from the SEER (Surveillance, Epidemiology and End Results) database for patients with histological diagnoses of PCAS; the extracted information included demographic, treatment and outcome data. RESULTS A total of 168 cases of PCAS from 1973 to 2013 were included. The mean age at diagnosis was 44.4 ± 15.5 years. PCAS was more prevalent in men than in women. The majority of PCAS patients were white (67.3%), while the incidence of PCAS in black individuals was relatively infrequent (19.0%). In addition, 87 cases were classified as distant stage, 44 as regional stage, and 33 as localized stage. The median disease-specific survival (DSS) was 7.22 months, and the 1-, 2- and 5-year DSS rate for PCAS patients was 34.7%, 14.3% and 10.2%, respectively. Further multivariate analyses showed that an age at (greater than or equal to) 45 years (HR 2.165), no radiotherapy (HR 1.629), tumour size > 5 cm (HR 3.182), and the summary stage was associated with worse PCAS-related survival. Cancer-directed surgery and radiotherapy significantly improved the DSS for patients with PCAS (P < 0.05). The C-index of the nomograms was 0.706 (95% CI 0.654-0.758), and the calibration curves showed good agreement between the nomogram prediction and actual observation. CONCLUSION PCAS is a rare cancer that is prone to have poor prognoses. To understand PCAS more thoroughly, more cases with adequate information are needed.
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20
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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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21
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Gallo A, Suriano M, Simonelli M, Ralli G, De Vincentiis M. Recurrent Malignant Schwannoma of the Parapharyngeal Space in Neurofibromatosis Type 1. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130308201112] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Andrea Gallo
- From the Department of Otolaryngology, La Sapienza University, Rome
| | - Maria Suriano
- From the Department of Otolaryngology, La Sapienza University, Rome
| | | | - Giovanni Ralli
- From the Department of Otolaryngology, La Sapienza University, Rome
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22
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Cannon RB, Kull AJ, Carpenter PS, Francis S, Buchmann LO, Monroe MM, Lloyd S, Hitchcock YJ, Cannon D, Weis JR, Houlton JJ, Hunt JP. Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database. Head Neck 2019; 41:1873-1879. [PMID: 30652375 DOI: 10.1002/hed.25619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. METHODS Patients (n = 1142) in the NCDB from 2004-2013 with adult H&N sarcomas who underwent resection and had a positive margin. RESULTS Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high-risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5-year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64-0.90]; P = .002). Treatment at a community-based facility was an independent predictor for reduced OS (HR: 1.37; [1.15-1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. CONCLUSION PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.
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Affiliation(s)
- Richard B Cannon
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Amanda J Kull
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Patrick S Carpenter
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Sam Francis
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Luke O Buchmann
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Marcus M Monroe
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Shane Lloyd
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Ying J Hitchcock
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Donald Cannon
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - John R Weis
- Division of Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Washington
| | - Jason P Hunt
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
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Head and Neck Sarcomas: A Review of Clinical and Imaging Findings Based on the 2013 World Health Organization Classification. AJR Am J Roentgenol 2018; 212:644-654. [PMID: 30589383 DOI: 10.2214/ajr.18.19894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Head and neck sarcomas are a complex, heterogeneous group of tumors that present a diagnostic challenge to radiologists because they have many overlapping imaging features. The purpose of this article is to review the imaging and clinical features and highlight distinguishing features of head and neck sarcomas. CONCLUSION An understanding of characteristic imaging and clinical features of head and neck sarcomas is important for the radiologist to narrow the differential diagnosis and help guide management.
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Hahn E, Huang SH, Hosni A, Razak AA, Jones RL, Dickson BC, Sturgis EM, Patel SG, O'Sullivan B. Ending 40 years of silence: Rationale for a new staging system for soft tissue sarcoma of the head and neck. Clin Transl Radiat Oncol 2018; 15:13-19. [PMID: 30582016 PMCID: PMC6293017 DOI: 10.1016/j.ctro.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
Abstract
For 40 years, all soft tissue sarcoma (STS) used the same TNM where T1 was <=5 cm. This staging is unsuited for STS of the head and neck (STSHN) since only a minority are >5 cm. Despite smaller size, local recurrence is higher in STSHN compared to other STS. A new T classification with 2 and 4 cm cut-offs for STSHN was introduced in TNM-8. Future requirements for STSHN Stage Group development are mentioned.
The tumor, node, metastases (TNM) anatomic staging system plays a pivotal role in cancer care, research, and cancer control activities. Since the first edition of the American Joint Committee on Cancer TNM staging classification published in 1977, soft tissue sarcomas have been staged in an anatomic site agnostic fashion whereby the primary tumor size (T) was categorized as T1 if <=5 cm and T2 if >5 cm; this remained unchanged through the 7th edition of the TNM. However, soft tissue sarcomas of the head and neck (STSHN) usually present smaller than sarcomas of other sites, but carry a disproportionate risk of local recurrence. Up to 70% of tumors are less than 5 cm at presentation, and therefore classified together as T1. Given the rarity of STSHN, there is a paucity of data to guide progress in their classification. Moreover, the majority of publications only report tumor size as less than or greater than 5 cm, presumably based on conventions of the TNM system that remained unchanged for 40 years, thereby affecting progress of STSHN classification. This formed the impetus for change in the 8th edition in 2 key ways: 1) several soft tissue sarcoma site based changes occurred including STSHN now having its own system, and 2) primary tumor size cut-offs of 2 cm and 4 cm used in STSHN now reflect sizes that head and neck specialists commonly encounter in their practice. This update was pragmatic in modifying the TNM from a system with a T category not serving STSHN and which was originally based on sarcoma data from non-head and neck anatomic sites. The background to this change is outlined which provides a framework in which data can be reported to generate evidence for future staging modifications.
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Affiliation(s)
- Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Albiruni Abdul Razak
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, United Kingdom
| | - Brendan C Dickson
- Department of Pathology & Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
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Sarcomas of the Oral and Maxillofacial Region: Analysis of 26 Cases with Emphasis on Diagnostic Challenges. Pathol Oncol Res 2018; 25:593-601. [PMID: 30382526 DOI: 10.1007/s12253-018-0510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Abstract
Sarcomas of the Oral and Maxillofacial Region (SOMR) are rare lesions which pose diagnostic and management challenges. We analyzed 26 cases of SOMR with respect to clinical presentation, histopathological subtype, treatment modalities, recurrence, and treatment outcome. In our series, Osteosarcoma (OS) was the most common type of sarcoma (7 cases), followed by 5 cases of Ewing's Sarcoma (ES), 3 cases each of Chondrosarcoma (CS) and Leiomyosarcoma (LMS), 2 cases each of Malignant Peripheral Nerve Sheath Tumor (MPNST), Pleomorphic Undifferentiated Sarcoma (PUS), Myeloid Sarcoma (MS)and Rhabdomyosarcoma (RMS). Surgery was the primary treatment modality in most cases and was combined with adjuvant chemo/ radiotherapy in few cases. 24 of the 26 cases were followed up for an average period of 40.67 months. Adverse disease outcomes like recurrence were seen in 2 cases whereas death due to the disease was reported in 7 cases. In view of the diagnostic challenges faced in SOMRs, it appears practical to stress on the underlying genetic aspects of the disease process rather than histological subtyping to improve disease outcome.
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26
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Kauke M, Safi AF, Grandoch A, Nickenig HJ, Zöller J, Kreppel M. Sarcomas of the sinonasal tract. Head Neck 2018; 40:1279-1286. [PMID: 29443431 DOI: 10.1002/hed.25108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/26/2017] [Accepted: 01/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sinonasal sarcomas are rare and heterogeneous in nature. Continuously collecting data influencing the prognosis is fundamental for optimizing therapeutic assessment of this highly destructive neoplasm. METHODS We conducted a single-institution retrospective cohort study considering 27 patients with sinonasal sarcoma. RESULTS The overall survival (OS) rates for 1 year and 5 years were calculated as 74% and 36%, respectively. Extent of the primary tumor (P = .010), nodal spread (P = .009), and age (P = .004) significantly reduced the OS. Disease-free survival (DFS) was significantly reduced by age (P = .003), extent of the primary (P = .006), nodal (P = .004), and hematogenous (P = .048) spread. Multimodal therapy including surgery improved the OS and DFS rates (P < .05). CONCLUSION Prognosis is poor due to late disease recognition. However, multimodal therapeutic regimens, including surgery, may improve the outcome.
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Affiliation(s)
- Martin Kauke
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim Zöller
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany
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Balducci M, Di Rito A, Mantini G, Manfrida S, Chiesa S, Frascino V, D'Agostino GR, Valentini V, De Bari B. Role of Radiotherapy in the Treatment of Fibrosarcoma of the Spermatic Cord: A Case Report and Review of the Literature. TUMORI JOURNAL 2018; 97:36e-8e. [DOI: 10.1177/030089161109700624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Spermatic cord sarcomas are rare. The therapeutic approach is based only on case reports and small series. The standard treatment is radical orchiectomy with wide local resection, while the role of adjuvant therapies is not clear. We present a case of fibrosarcoma of the spermatic cord treated with surgery and adjuvant radiotherapy. A review of the literature about the role of adjuvant treatments is also discussed. Case Report A 59-year-old man presented a right testicular mass of about 4 × 3 cm in size. Biopsy showed a high-grade polymorphous sarcoma, consistent with a diagnosis of poorly differentiated fibromyosarcoma. He underwent a right radical inguinal orchiectomy and adjuvant radiotherapy (total dose: 5940 cGy). During treatment the patient developed a G3 skin toxicity (RTOG score) in the inguinal fold. After a follow-up of 57 months, he is alive and without evidence of local or distant recurrence. No late toxicity was noted. Conclusion The optimal adjuvant management of spermatic cord sarcoma is still uncertain. Looking at the literature, it seems that adjuvant radiotherapy can improve locoregional control and disease-free survival without additional late toxicity.
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Affiliation(s)
- Mario Balducci
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Alessia Di Rito
- Service de Radiothérapie, Centre Medical de Forcilles, Ferolles-Attilly, France
| | - Giovanna Mantini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Stefania Manfrida
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Silvia Chiesa
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Vincenzo Frascino
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | | | - Vincenzo Valentini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Berardino De Bari
- Service de Radiothérapie-Oncologie, Centre Hospitalier Lyon-Sud, Pierre Benite, France
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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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Makary RF, Gopinath A, Markiewicz MR, Fernandes R. Margin Analysis. Oral Maxillofac Surg Clin North Am 2017; 29:355-366. [DOI: 10.1016/j.coms.2017.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosko AJ, Birkeland AC, Chinn SB, Shuman AG, Prince ME, Patel RM, McHugh JB, Spector ME. Survival and Margin Status in Head and Neck Radiation-Induced Sarcomas and De Novo Sarcomas. Otolaryngol Head Neck Surg 2017; 157:252-259. [PMID: 28397585 DOI: 10.1177/0194599817700389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective To describe histologic subtypes and oncologic outcomes among patients with radiation-induced and de novo sarcomas of the head and neck. Study Design Retrospective case series with chart review. Setting Tertiary academic center. Subject and Methods In total, 166 adult patients with sarcoma of the head and neck treated from January 1, 1985, to January 1, 2010, were included. Tumors were characterized as radiation induced (15.1%) vs de novo sarcomas (84.9%). Clinical and tumor characteristics were compared. The primary outcomes were overall survival (OS) and disease-specific survival (DSS). Results Radiation-induced sarcomas were more likely to be high grade ( P = .006) and advanced stage ( P = .03). Chondrosarcoma was more common in de novo tumors ( P = .02) while leiomyosarcoma ( P = .01), sarcoma not otherwise specified ( P = .02), and undifferentiated pleomorphic sarcoma ( P < .001) were more common in radiation-induced sarcomas. Radiation-induced sarcomas were associated with statistically significantly worse DSS ( P = .019) and OS ( P = .005) compared with de novo sarcomas, but when only high-grade soft tissue sarcomas were analyzed, neither DSS ( P = .48) nor OS ( P = .29) differed. Margin status was a significant predictor of survival as both R0 and R1 resections correlated with statistically better DSS and OS compared with R2 ( P < .001) resections and patients treated with radiation therapy/chemoradiation therapy alone ( P = .005). Conclusion Radiation-induced sarcomas of the head and neck correlate with worse survival compared with de novo tumors; however, when controlling for tumor grade and resection status, there is no statistically significant difference in observed outcomes.
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Affiliation(s)
- Andrew J Rosko
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C Birkeland
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew G Shuman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Prince
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajiv M Patel
- 2 Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- 2 Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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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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König M, Osnes TA, Lobmaier I, Bjerkehagen B, Bruland ØS, Sundby Hall K, Meling TR. Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years. Neurosurg Rev 2016; 40:449-460. [PMID: 27858303 DOI: 10.1007/s10143-016-0802-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/06/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway. .,Department of Neurology, Ostfold Hospital Trust, 300, Gralum, 1714, Norway. .,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.
| | - Terje A Osnes
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Otorhinolaryngology, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Øyvind S Bruland
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Kirsten Sundby Hall
- Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway.,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway
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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes. J Laryngol Otol 2016; 130:850-9. [PMID: 27476336 DOI: 10.1017/s0022215116008604] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment. OBJECTIVES This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes. METHODS Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method. RESULTS The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx. CONCLUSION Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.
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Selçuk ÖT, Renda L, Erol B, Osma Ü, Eyigor H, Öztürk H. A case of laryngeal leiomyosarcoma and review of the literature. Ann Maxillofac Surg 2016; 5:274-6. [PMID: 26981488 PMCID: PMC4772578 DOI: 10.4103/2231-0746.175772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Leiomyosarcoma (LMS) of the larynx is a very rare malignancy that originates from blood vessel, smooth muscle or from the heterotopic mesenchymal tissue in the larynx. The histological diagnosis of LMS depends on the immunohistochemical investigation. The case is here presented of an 82-year-old man with shortness of breath and hoarseness. Indirect laryngoscopy showed a pedunculated large glottic lesion causing airway obstruction. Direct laryngoscopy was performed and biopsies were taken. From the pathological examination, the diagnosis of LMS was made. This case is presented of laryngeal LMS with the clinical, radiological, and histological findings.
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Affiliation(s)
- Ömer Tarik Selçuk
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Levent Renda
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Bekir Erol
- Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Üstün Osma
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hülya Eyigor
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hülya Öztürk
- Department of Patology, Antalya Training and Research Hospital, Antalya, Turkey
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Galy-Bernadoy C, Garrel R. Head and neck soft-tissue sarcoma in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:37-42. [DOI: 10.1016/j.anorl.2015.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Andrä C, Rauch J, Li M, Ganswindt U, Belka C, Saleh-Ebrahimi L, Ballhausen H, Nachbichler SB, Roeder F. Excellent local control and survival after postoperative or definitive radiation therapy for sarcomas of the head and neck. Radiat Oncol 2015; 10:140. [PMID: 26156022 PMCID: PMC4496934 DOI: 10.1186/s13014-015-0449-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/26/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To report our results with postoperative or definitive radiation therapy in head and neck sarcomas. METHODS We performed a retrospective analysis of 26 patients suffering from head and neck sarcomas, who received postoperative or definitive radiation therapy between 2003 and 2012. Median age was 64 years (19-88) and 69 % were male. Tumor locations were skull (including skin) in 31 %, paranasal sinus/orbita in 27 % and neck (including pharynx/larynx) in 42 %. Median tumor size was 4.6 cm (1-12 cm). 22 patients (85 %) presented in primary situation. Stage at presentation (UICC 7(th) for soft tissue sarcomas) was as follows: Ia:4 %, IIa:50 %, IIb:15 %, III:31 %. All except one patient suffered from high grade lesions (G2/3 FNCLCC), predominantly angiosarcoma (35 %), MFH (19 %) and synovial sarcoma (15 %). Surgery was performed in 21 pts (81 %), resulting in free margins in 10 (38 %), microscopically positive margins in 6 (23 %) and gross residual disease in 5 (19 %). Median dose to the primary tumor region was 66Gy (45-72Gy) in conventional fractionation, using 3D-CRT in 65 %, IMRT in 27 % and electrons in 8 %. 50 % of the patients also received sequential chemotherapy. RESULTS Median follow up was 39 months (8-136). We observed three local recurrences, transferring into estimated 3- and 5-year local control rates of 86 %. One additional patient failed distantly, resulting in 3- and 5-year freedom from treatment failure rates of 82 %. Four patients have deceased, transferring into 3- and 5-year overall survival rates of 88 % and 82 %, respectively. Only two of the four deaths were sarcoma related. Maximum acute toxicity (CTCAE 3.0) was grade 1 in 27 % of the patients, grade 2 in 50 % and grade 3 in 23 %. Severe acute toxicity was mainly represented by mucositis and dysphagia. Maximum late toxicity was grade 1 in 31 %, grade 2 in 15 % and grade 3 in 19 % of the patients. Severe late toxicity included skin ulceration (n = 1), dysphagia with persistent tube dependency (n = 1), persistent sinusitis (n = 1) and hearing loss (n = 2). CONCLUSION Excellent local control and overall survival rates can be achieved with postoperative or definitive radiation therapy with acceptable acute and late toxicities in patients suffering from sarcomas of the head and neck region.
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Affiliation(s)
- Claudia Andrä
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Josefine Rauch
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Minglun Li
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Ladan Saleh-Ebrahimi
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Hendrik Ballhausen
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Silke Birgit Nachbichler
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Falk Roeder
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. .,Department of Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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De Amorim Bernstein K, Delaney TF. Role of radiation therapy for non-extremity soft tissue sarcomas. J Surg Oncol 2014; 111:604-14. [PMID: 25556548 DOI: 10.1002/jso.23863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/15/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Negative surgical margins are uncommon for non-extremity soft tissue sarcomas. Radiation therapy is usually recommended to improve local control; however, appropriate RT dosing is challenging due to nearby dose-limiting normal structures. MATERIAL AND METHODS Comprehensive literature search using PubMed (March 2014). RESULTS Data suggest radiation therapy is an important modality in maximizing local tumor control in non-extremity sarcomas. CONCLUSION The literature supports the use of RT to improve local control for non-extremity soft tissue sarcomas.
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Chang AE, Chai X, Pollack SM, Loggers E, Rodler E, Dillon J, Parvathaneni U, Moe KS, Futran N, Jones RL. Analysis of Clinical Prognostic Factors for Adult Patients with Head and Neck Sarcomas. Otolaryngol Head Neck Surg 2014; 151:976-83. [DOI: 10.1177/0194599814551539] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the treatment, outcome, and prognostic factors in patients with head and neck sarcomas treated in an academic medical center. Study Design Case series. Setting Academic medical center. Subjects and Methods We performed a retrospective analysis of adult patients (n = 97) with primary head and neck sarcomas treated between 2000 and 2012. We analyzed the treatment, outcome, and potential factors predictive of disease-free survival and disease-specific survival. We also evaluated the outcome and prognostic factors in patients with bone and soft tissue sarcomas. Results The median overall survival was 6.8 years, with 2-year and 5-year overall survival rates of 78% (95% confidence interval [CI], 66%-86%) and 59% (95% CI, 44%-72%), respectively. Univariable analysis revealed that age at diagnosis (>60 years: hazard ratio [HR], 2.7; 95% CI, 1.2-6.2; P = .01), surgical intervention (HR, 8.3; 95% CI, 3.5-19.5; P < .001), and metastatic disease (HR, 4.3; 95% CI, 1.3-13.6; P = .01) were significantly associated with disease-specific survival. Conclusion In this study, patients over the age of 60 years at diagnosis and those with inoperable disease at initial presentation had significantly worse disease-specific survival. Surgical intervention remains the optimal treatment modality for those with resectable disease and was associated with significantly better survival in this heterogeneous series. Further multi-institutional studies are required to better define prognostic factors in individual histological subtypes.
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Affiliation(s)
- Amy E. Chang
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Xiaoyu Chai
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Seth M. Pollack
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Elizabeth Loggers
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Eve Rodler
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Jasjit Dillon
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, USA
| | - Kris S. Moe
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA
| | - Neal Futran
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA
| | - Robin L. Jones
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
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Peng KA, Grogan T, Wang MB. Head and neck sarcomas: analysis of the SEER database. Otolaryngol Head Neck Surg 2014; 151:627-33. [PMID: 25135525 DOI: 10.1177/0194599814545747] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To summarize the epidemiology of sarcomas occurring in the head and neck and identify prognostic factors for patient survival. STUDY DESIGN AND SETTING Cross-sectional analysis of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. METHODS The SEER 18 registries, comprising sarcoma diagnoses made from 1973 to 2010, were queried for sarcomas arising in the head and neck. Pediatric and adult patients were analyzed separately, and multivariate and propensity-matched analyses were performed to identify predictors of disease-specific survival. RESULTS In all, 11,481 adult cases and 1244 pediatric cases were identified. In adults, the most common histologic subtypes were malignant fibrous histiocytoma (MFH), Kaposi sarcoma, and hemangiosarcoma, while in the pediatric cohort, the most common histologic subtypes were rhabdomyosarcoma, MFH, and osteosarcoma. Cause-specific 2-, 5-, and 10-year survival rates were 76%, 66%, and 61% for adults and 84%, 73%, and 71% for pediatric patients. Multivariate analysis performed for adults revealed that male gender, absence of radiation therapy, and stage I disease were associated with improved cause-specific survival reaching statistical significance. However, a propensity-matched model demonstrated no significant difference in cause-specific survival between patients who received radiation and those who did not. CONCLUSION Sarcomas, a heterogeneous group of malignant mesenchymal tumors, are uncommonly found in the head and neck. This study represents the largest analysis of patients with head and neck sarcomas in the literature and demonstrates the impact of age, gender, primary site, histology, and radiation status on overall prognosis.
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Affiliation(s)
- Kevin A Peng
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Tristan Grogan
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Gamoh S, Nakashima Y, Akiyama H, Tsuji K, Yamada K, Suzuki M, Morita S, Shimizutani K. Fibrosarcoma of the temporomandibular joint area: benefits of magnetic resonance imaging and computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:262-6. [PMID: 24704157 DOI: 10.1016/j.oooo.2014.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/29/2013] [Accepted: 02/04/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Shoko Gamoh
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan.
| | - Yukako Nakashima
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan
| | - Hironori Akiyama
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan
| | - Kaname Tsuji
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Koji Yamada
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Motoyuki Suzuki
- Department of Otolaryngology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Shosuke Morita
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
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Soft tissue sarcomas of the head and neck. Clinical and pathological evaluation of 108 cases in Mexico. J Craniomaxillofac Surg 2014; 42:1566-71. [PMID: 24704280 DOI: 10.1016/j.jcms.2014.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/05/2013] [Accepted: 01/06/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sarcomas constitute 1% of all malignancies, but 10% occur in the head and neck (HN), and they are poorly understood. We present a large series of Soft Tissue HN sarcomas in Mexican patients with survival analysis. STUDY DESIGN This is a retrospective study of cases in a cancer hospital. METHODS Review of files and pathology material. Literature review. RESULTS We analysed 108 patients (55 men / 53 women). The age at presentation was 37 years. The original diagnosis changed in nine cases (8.3%). The most common subtype was rhabdomyosarcoma. Ninety percent of tumours were deep, 91% were high grade, 44% had metastasis, 63% measured >5 cm, overall 5-year survival (5 y-OS) was 48%, and histological high grade was associated with poor survival (p = 0.026). CONCLUSION Sarcomas of the HN are rare. The most affected sites were paranasal sinuses. The majority of tumours were deep, > 5 cm and high grade, 50% had metastasis, the 5 y-OS was 48% and the only independent factor associated with 5 y-OS was histologic grade.
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Swain N, Kumar SV, Dhariwal R, Routray S. Primary fibrosarcoma of maxilla in an 8-year-old child: A rare entity. J Oral Maxillofac Pathol 2014; 17:478. [PMID: 24574679 PMCID: PMC3927362 DOI: 10.4103/0973-029x.125226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fibrosarcoma (FS) is a malignant mesenchymal neoplasm of the fibroblasts that is uncommon in the head and neck and constitutes less than 1% of malignancies and approximately 6% of the soft tissue sarcomas. FSs rarely occur before the third decade except infantile type. This condition primarily affects long bones, and its occurrence in the cranium is rare (15%), with the mandible being the most commonly involved cranial site. Here a case of primary FS in anterior maxilla of an 8-year-old male child is reported. This article is presented to document the rarity of FSs in the jaws of children with review of literature.
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Affiliation(s)
- Niharika Swain
- Department of Oral Pathology, Mahatma Gandhi Mission Dental College and Hospital, Kamothe, Navi, Mumbai, Maharashtra, India
| | - Shwetha V Kumar
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Richa Dhariwal
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Samapika Routray
- Department of Oral Pathology, Institute of Dental Sciences, Bhubaneswar, Odisha, India
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Rapidis AD. Sarcomas of the head and neck in adult patients: current concepts and future perspectives. Expert Rev Anticancer Ther 2014; 8:1271-97. [DOI: 10.1586/14737140.8.8.1271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Akatsuka J, Suzuki Y, Hamasaki T, Kimura G, Osawa S, Kondo Y. Spindle cell sarcoma of the epididymis. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ravo V, Falivene S, De Chiara A, De Palma G, Pizzolorusso A, Di Franco R, Muto P, Apice G. Treatment of Cutaneous Angiosarcoma of the Face: Efficacy of Combined Chemotherapy and Radiotherapy. TUMORI JOURNAL 2013; 99:e211-5. [DOI: 10.1177/030089161309900515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Cutaneous angiosarcoma (AS) is a rare form of soft tissue sarcoma. It is aggressive and has a poor prognosis. The aim of our report is to show that with combined chemotherapy and radiotherapy it is possible to obtain good results in terms of local control, complete response, and aesthetic outcome. Case report We present the case of a 60-year-old man affected by AS covering the entire surface of the nose. Surgery, although indicated, was excluded because it was considered mutilating and would give a poor cosmetic result. The patient was treated with chemotherapy consisting of paclitaxel 80 mg/m2 for 6 cycles followed by radiotherapy at a dose of 50 Gy. Then 3 additional cycles of chemotherapy were administered according to the same scheme. A complete response was obtained. At 40 months after treatment, the patient did not show any signs of late toxicity, all lesions had disappeared, and all laboratory tests were negative. Conclusions Our experience shows that concomitant chemoradiotherapy can be delivered safely and can be tolerated with low toxicity and good results in terms of local control and complete response. We obtained an excellent aesthetic result with improvement of the patient's quality of life.
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Affiliation(s)
- Vincenzo Ravo
- UOC Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples
| | - Sara Falivene
- Dipartimento Diagnostica per Immagini e Radioterapia, Seconda Università degli Studi di Napoli, Naples
| | - Annarosaria De Chiara
- Dipartimento di Patologia Diagnostica e di Laboratorio, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples, Italy
| | - Giampaolo De Palma
- UOC Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples
| | - Antonio Pizzolorusso
- Dipartimento Oncologia Sarcomi, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples, Italy
| | - Rossella Di Franco
- Dipartimento Diagnostica per Immagini e Radioterapia, Seconda Università degli Studi di Napoli, Naples
| | - Paolo Muto
- UOC Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples
| | - Gaetano Apice
- Dipartimento Oncologia Sarcomi, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale”, IRCCS, Naples, Italy
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Mattavelli D, Miceli R, Radaelli S, Mattavelli F, Cantù G, Barisella M, Quattrone P, Stacchiotti S, Sangalli C, Casali P, Gronchi A, Fiore M. Head and neck soft tissue sarcomas: prognostic factors and outcome in a series of patients treated at a single institution. Ann Oncol 2013; 24:2181-9. [DOI: 10.1093/annonc/mdt126] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tejani MA, Galloway TJ, Lango M, Ridge JA, von Mehren M. Head and neck sarcomas: a comprehensive cancer center experience. Cancers (Basel) 2013; 5:890-900. [PMID: 24202325 PMCID: PMC3795370 DOI: 10.3390/cancers5030890] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/20/2013] [Accepted: 06/18/2013] [Indexed: 11/25/2022] Open
Abstract
Head/neck sarcomas are rare, accounting for about 1% of head/neck malignancies and 5% of sarcomas. Outcomes have historically been worse in this group, due to anatomic constraints leading to difficulty in completely excising tumors, with high rates of local recurrence. We retrospectively analyzed cases of head/neck soft tissue sarcomas (STS) and osteogenic sarcomas managed in a multi-disciplinary setting at Fox Chase Cancer Center from 1999–2009 to describe clinicopathologic characteristics, treatment, outcomes, and prognostic factors for disease control and survival. Thirty patients with STS and seven patients with osteogenic sarcoma were identified. Most STS were high grade (23) and almost all were localized at presentation (28). Common histologies were synovial cell (6), rhabdomyosarcoma (5), angiosarcoma (4), liposarcoma (4) and leiomyosarcoma (3). The type of primary therapy and disease outcomes were analyzed. Cox proportional hazards regression analysis was performed to identify predictors of disease-free survival (DFS) and overall survival (OS). The HR and 95% CI for Cox model and median DFS/OS analyzed by Kaplan-Meier curves were calculated.
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Affiliation(s)
- Mohamedtaki A. Tejani
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA; E-Mail:
| | - Thomas J. Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; E-Mail:
| | - Miriam Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; E-Mails: (M.L.); (J.A.R.)
| | - John A. Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; E-Mails: (M.L.); (J.A.R.)
| | - Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-215-728-2814; Fax: +1-215-728-3639
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Retrospective review of soft tissue sarcoma of head and neck in a West African hospital. ALEXANDRIA JOURNAL OF MEDICINE 2013. [DOI: 10.1016/j.ajme.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Amal B, El Fatemi H, Souaf I, Moumna K, Affaf A. A rare primary tumor of the thyroid gland: report a new case of leiomyosarcoma and literature review. Diagn Pathol 2013; 8:36. [PMID: 23445571 PMCID: PMC3599845 DOI: 10.1186/1746-1596-8-36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/20/2013] [Indexed: 02/06/2023] Open
Abstract
Primary leiomyosarcomas of the thyroid gland are extremely rare. we report a case of a 72 year-old women with a painful growing mass of the left neck with skin fistula. The patient underwent a lobectomy. The tumor histology showed spindle-shaped cells arranged in interlacing fascicles that expressed desmine and Hcaldesmone, but were negative for cytokeratins and thyroglobulin. Total body CT scan didnt show any other tumor. The patient died two months after surgery. Primary thyroid leiomyosarcoma may be mistaken for other tumors, such as anaplastic or medullary carcinomas. Therefore, the diagnosis is difficult and requires numerous clinical, radiological, and pathological investigations.
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Affiliation(s)
- Bennani Amal
- Departement of pathology, Hassan II University Hospital, Fez 30000, Morocco.
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