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To analyse the experience treating soft tissue sarcomas of the head and neck at the Massachusetts General Hospital, Boston. Detailed results have been published previously [17].Between 1972 and 1993, 57 patients were treated curatively with radiation alone (n = 13) or combined surgery and pre- and/or postoperative irradiation (n = 44). Gross complete resection was achieved in 82% of patients and margins were negative in 5 patients. Doses ranged from 36.0 to 79.2 Gy (median 64.8 Gy), usually conventionally fractionated. In 16 patients protons were used. Median follow-up time was 4.3 years (range 1.1 to 16.8 years).After 5 years, patients with angiosarcomas (n = 11) and patients with other tumor types (n = 46) had locoregional control rates of 24% and 69%, distant failure rates of 58% and 17%, and overall survival rates of (for overall survival) and T stage (for locoregional control) (p0.05). Particularly, gross completely resected T1 tumors had a locoregional control rate of 91%. Patients with locoregional recurrence were at an increased risk to die (p = 0.004 in multivariate analysis). Patients with and without direct tumor extension to neurovascular structures, bones, organs, or skin had distant failure rates of 27% and 0%, respectively (p = 0.031). In multivariate analysis, direct extension was additionally a negative prognosticator of overall survival (p = 0.034).1. Angiosarcomas of the head and neck have a considerably poorer prognosis than other soft tissue sarcomas of this region. 2. Head and neck sarcomas have a higher local recurrence rate than for example soft tissue sarcomas of the extremities. Optimisation of local treatment through combination of surgery and high-dose irradiation, however, can achieve improved results, especially for prognostically favourable subgroups. 3. In addition to tumor grade and size, direct tumor extension may be a useful additional staging parameter. |
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