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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes

Published online by Cambridge University Press:  01 August 2016

M Stavrakas ,
I Nixon ,
K Andi ,
R Oakley ,
J P Jeannon ,
A Lyons ,
M McGurk ,
T Guerrero Urbano ,
S Thavaraj  and
R Simo
M Stavrakas*
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
I Nixon
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
K Andi
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
R Oakley
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
J P Jeannon
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
A Lyons
Affiliation:
Department of Oral and Maxillofacial Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
M McGurk
Affiliation:
Department of Oral and Maxillofacial Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
T Guerrero Urbano
Affiliation:
Department of Clinical Oncology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
S Thavaraj
Affiliation:
Department of Oral and Head and Neck Pathology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
R Simo
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas’ NHS Foundation Trust, London, UK
*
Address for correspondence: Dr Marios Stavrakas, Department of Otorhinolaryngology Head and Neck Surgery, 3rd Floor Southwark Wing, Guy's Hospital, St Thomas Street, London SE1 9RT, UK E-mail: [email protected]
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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.

Keywords

SarcomaHead And Neck CancerSarcoma ManagementKaposi SarcomaOsteosarcomaChondrosarcoma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 9 , September 2016 , pp. 850 - 859
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1 Yamaguchi, S, Nagasawa, H, Suzuki, T, Fujii, E, Iwaki, H, Takagi, M et al. Sarcomas of the oral and maxillofacial region: a review of 32 cases in 25 years. Clin Oral Investig 2004;8:52–5Google Scholar
2 Chang, AE, Rosenberg, S, Glastein, E, Antman, K. Sarcomas of soft tissues. In: DeVita, VT, Rosenberg, SA, Hellman, S, eds. Cancer: Principles and Practice of Oncology, 3rd edn. Philadelphia: Lippincott Williams & Wilkins, 1989;1345–98Google Scholar
3 Greene, F, Page, D, Fleming, I, Fritz, A, Balch, C, Haller, D et al. , eds. American Joint Committee on Cancer: AJCC Cancer Staging Manual, 6th edn. New York: Springer, 2002;77–87 CrossRefGoogle Scholar
4 Jemal, A, Murray, T, Ward, E, Samuels, A, Tiwari, RC, Ghafoor, A et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30 CrossRefGoogle ScholarPubMed
5 Colville, RJ, Charlton, F, Kelly, CG, Nicoll, JJ, McLean, NR. Multidisciplinary management of head and neck sarcomas. Head Neck 2005;27:814–24Google Scholar
6 Wanebo, HJ, Koness, RJ, Macfarlane, JK, Eilber, FR, Byers, RM, Elias, EG et al. Head and neck sarcoma: report of the Head and Neck Sarcoma Registry. Head Neck 2006;14:1–7 Google Scholar
7 Patel, SG, Shaha, AR, Shah, JP. Soft tissue sarcomas of the head and neck: an update. Am J Otolaryngol 2001;22:2–18 Google Scholar
8 Kraus, DH, Dubner, S, Harrison, LB, Strong, EW, Hajdu, SI, Kher, U et al. Prognostic factors for recurrence and survival in head and neck soft tissue sarcomas. Cancer 2006;74:697–702 Google Scholar
9 Bentz, BG, Singh, B, Woodruff, J, Brennan, M, Shah, JP, Kraus, D. Head and neck soft tissue sarcomas: a multivariate analysis of outcomes. Ann Surg Oncol 2004;11:619–28CrossRefGoogle ScholarPubMed
10 Ketabchi, A, Kalavrezos, N, Newman, L. Sarcomas of the head and neck: a 10-year retrospective of 25 patients to evaluate treatment modalities, function and survival. Br J Oral Maxillofac Surg 2011;49:116–20CrossRefGoogle ScholarPubMed
11 Aljabab, A, Nason, R, Kazi, R, Pathak, K. Head and neck soft tissue sarcoma. Indian J Surg Oncol 2011;2:286–90Google Scholar
12 Rinaldo, A, Howard, DJ, Ferlito, A. Laryngeal chondrosarcoma: a 24-year experience at the Royal National Throat, Nose and Ear Hospital. Acta Otolaryngol 2000;120:680–8Google Scholar
13 Nieweg, O, Hoekstra, H, Pruim, J. In vivo grading of soft tissue sarcomas with positron emission tomography. Proc Ann Meet Soc Surg Oncol 1994;225 Google Scholar
14 Allen, P, Allen, L. Perce the permissive pathologist: a cautionary tale of one who misdiagnosed a pseudosarcoma, killed the patient and was found out. Aust N Z J Surg 1994;64:273–4CrossRefGoogle ScholarPubMed
15 Flens, MJ, Valk, PV, Tadema, TM, Huysmans, AC, Risse, EK, Van Tol, GA et al. The contribution of immunocytochemistry in diagnostic cytology. Comparison and evaluation with immunohistology. Cancer 1990;65:2704–11Google Scholar
16 National Institute for Health and Clinical Excellence. Improving Outcomes for People with Sarcoma: The Manual. London: National Institute for Health and Clinical Excellence, 2006 Google Scholar
17 Zagars, GK, Ballo, MT, Pisters, PW, Pollock, RE, Patel, SR, Benjamin, RS et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy. Cancer 2003;97:2530–43Google Scholar
18 Van Damme, J, Schmitz, S, Machiels, J, Galant, C, Grégoire, V, Lengelé, B et al. Prognostic factors and assessment of staging systems for head and neck soft tissue sarcomas in adults. Eur J Surg Oncol 2010;36:684–90CrossRefGoogle ScholarPubMed
19 Clark, JL, Unni, KK, Dahlin, DC, Devine, KD. Osteosarcoma of the jaw. Cancer 2006;51:2311–16Google Scholar
20 Bertoni, F, Dallera, P, Bacchini, P, Marchetti, C, Campobassi, A. The Istituto Rizzoli-Beretta experience with osteosarcoma of the jaw. Cancer 2006;68:1555–63Google Scholar
21 Singh, RP, Grimer, RJ, Bhujel, N, Carter, SR, Tillman, RM, Abudu, A. Adult head and neck soft tissue sarcomas: treatment and outcome. Sarcoma 2008;2008:654987 Google Scholar
22 Granados-Garcia, M, Luna-Ortiz, K, Castillo-Oliva, HA, Villavicencio-Valencia, V, Herrera-Gómez, A, Mosqueda-Taylor, A et al. Free osseous and soft tissue surgical margins as prognostic factors in mandibular osteosarcoma. Oral Oncol 2006;42:172–6Google Scholar
23 August, M, Magennis, P, Dewitt, D. Osteogenic sarcoma of the jaws: factors influencing prognosis. Intl J Oral Maxillofac Surg 1997;26:198–204 Google Scholar
24 de Bree, R, van der Valk, P, Kuik, DJ, van Diest, PJ, Doornaert, P, Buter, J et al. Prognostic factors in adult soft tissue sarcomas of the head and neck: a single-centre experience. Oral Oncol 2006;42:703–9CrossRefGoogle ScholarPubMed
25 Penel, N, Van Haverbeke, C, Lartigau, E, Vilain, M, Ton Van, J, Mallet, Y et al. Head and neck soft tissue sarcomas of adult: prognostic value of surgery in multimodal therapeutic approach. Oral Oncol 2004;40:890–7Google Scholar
26 Dudhat, SB, Mistry, RC, Varughese, T, Fakih, AR, Chinoy, RF. Prognostic factors in head and neck soft tissue sarcomas. Cancer 2000;89:868–72Google Scholar
27 Kraus, DH. Sarcomas of the head and neck. Curr Oncol Rep 2002;4:68–75 CrossRefGoogle ScholarPubMed
28 Barrera, F, López, G, Gómez, G, Meneses, G. Head and neck sarcomas in adults [in Spanish]. Rev Inst Nal Cancerol Méx 1997;43:184–8Google Scholar
29 Tran, LM, Mark, R, Meier, R, Calcaterra, TC, Parker, RG. Sarcomas of the head and neck. Prognostic factors and treatment strategies. Cancer 2006;70:169–773.0.CO;2-F>CrossRefGoogle Scholar
30 Eeles, R, Fisher, C, A'Hern, R, Robinson, M, Rhys-Evans, P, Henk, J et al. Head and neck sarcomas: prognostic factors and implications for treatment. Br J Cancer 1993;68:201–7Google Scholar
31 Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet 1997;350:1647–54Google Scholar
32 Salvati, M, Ciappetta, P, Raco, A. Osteosarcomas of the skull. Clinical remarks on 19 cases. Cancer 2006;71:2210–163.0.CO;2-W>CrossRefGoogle Scholar
33 Delgado, R, Maafs, E, Alfeiran, A, Mohar, A, Barrera, J, Zinser, J et al. Osteosarcoma of the jaw. Head Neck 2006;16:246–52Google Scholar
34 Ramírez-Amador, V, Martínez-Mata, G, González-Ramírez, I, Anaya-Saavedra, G, De Almeida, O. Clinical, histological and immunohistochemical findings in oral Kaposi's sarcoma in a series of Mexican AIDS patients. Comparative study. J Oral Pathol Med 2009;38:328–33Google Scholar
35 Feller, L, Wood, NH, Lemmer, J. HIV-associated Kaposi sarcoma: pathogenic mechanisms. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:521–9Google Scholar
36 Fletcher, C. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology 2006;48:3–12 Google Scholar
37 Patrikidou, A, Vahtsevanos, K, Charalambidou, M, Valeri, R, Xirou, P, Antoniades, K. Non-AIDS Kaposi's sarcoma in the head and neck area. Head Neck 2009;31:260–8CrossRefGoogle ScholarPubMed
38 Di Lorenzo, G. Update on classic Kaposi sarcoma therapy: new look at an old disease. Crit Rev Oncol Hematol 2008;68:242–9Google Scholar
39 Brambilla, L, Boneschi, V, Taglioni, M, Ferrucci, S. Staging of classic Kaposi's sarcoma: a useful tool for therapeutic choices. Eur J Dermatol 2003;13:83–6Google ScholarPubMed
40 Di Lorenzo, G, Konstantinopoulos, PA, Pantanowitz, L, Di Trolio, R, De Placido, S, Dezube, BJ. Management of AIDS-related Kaposi's sarcoma. Lancet Oncol 2007;8:167–76Google Scholar
41 Cheung, MC, Pantanowitz, L, Dezube, BJ. AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy. Oncologist 2005;10:412–26Google Scholar
42 Aversa, SM, Cattelan, AM, Salvagno, L, Crivellari, G, Banna, G, Trevenzoli, M et al. Treatments of AIDS-related Kaposi's sarcoma. Crit Rev Oncol Hematol 2005;53:253–65Google Scholar
43 Krown, SE. Highly active antiretroviral therapy in AIDS-associated Kaposi's sarcoma: implications for the design of therapeutic trials in patients with advanced, symptomatic Kaposi's sarcoma. J Clin Oncol 2004;22:399–402 Google Scholar
44 Mendenhall, WM, Mendenhall, CM, Werning, JW, Riggs, CE, Mendenhall, NP. Adult head and neck soft tissue sarcomas. Head Neck 2005;27:916–22Google Scholar
45 Parsons, JT, Zlotecki, RA, Reddy, KA, Mitchell, TP, Marcus, RB, Scarborough, MT. The role of radiotherapy and limb-conserving surgery in the management of soft-tissue sarcomas in adults. Hematol Oncol Clin North Am 2001;15:377–88Google Scholar
46 O'Sullivan, B, Gullane, P, Irish, J, Neligan, P, Gentili, F, Mahoney, J et al. Preoperative radiotherapy for adult head and neck soft tissue sarcoma: assessment of wound complication rates and cancer outcome in a prospective series. World J Surg 2003;27:875–83Google Scholar