Ron Allison MD, Presenter: Nothing to Disclose

Purpose/Objective(s): Sarcoma arising in the head and neck region is rare. Most series include patients diagnosed and treated over multiple decades making outcomes difficult to extrapolate to current patients. We examined outcomes for a modern cohort of these patients.Materials/Methods: An IRB approved retrospective review of our database returned 1,082 sarcoma cases and reported 11 patients (8 male, 3 female) with biopsy proven primary sarcoma of the head and neck. Tumor was felt to originate in the maxillary sinus (n=2) and one each from the nasal passage, parotid, soft palate, thyroid and sublingual gland. Four patients had tumor originate in the soft tissues of the neck. Histology included leiomyosarcoma, liposarcoma, spindle cell sarcoma, fibrosarcoma, synovial sarcoma, granular sarcoma and angiosarcoma. Presentation was most commonly due to enlarging mass/swelling (64%) or pain (9%). One patient had prior larynx radiation therapy and one was with neurofibromatosis. All patients underwent excision, with neck dissection in 5 patients. Two patients underwent chemotherapy. Postoperative radiation was delivered to all patients through intensity modulated radiation therapy (n=7) or 3D radiation therapy (n=4). Image guidance was employed for 5 patients. The mean photon radiation dose was 64 Gray.Results: All patients have been followed. Treatment was well tolerated with only one patient experiencing a grade 3 complication. Late complications were most commonly xerostomia (27%). Local recurrence has occurred in 7 patients, 3 of whom also have distant failure, mainly in the lungs. Two patients are without failure. No statistically significant variable was found in terms of survival or local control when examining surgery, extent of disease, type of sarcoma, chemotherapy, radiation field size or radiation dose. Overall survival is 34% at 36 months.Conclusions: Sarcoma of the head and neck region is rare. Surgery followed by full dose photon radiation leads to high local failure rates, distant failure and a poor overall survival. The use of chemotherapy in this series was limited to two patients, both of whom failed locally. While the number of patients in this series was small this likely summarizes current management techniques and bodes for the need for innovative means to address this diagnosis.

Allison, R, Modern Management of Sarcoma of the Head and Neck.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14041293.html