ADULT SOFT-TISSUE SARCOMAS OF THE HEAD AND NECK TREATED BY RADIATION AND SURGERY OR RADIATION ALONE - PATTERNS OF FAILURE AND PROGNOSTIC FACTORS

Purpose: To analyze our experience treating soft tissue sarcomas of th e head and neck in adults, and to identify patterns of failure and pro gnostic factors.Methods and Materials: The records of 57 patients with Stage MO disease treated by radiation with or without surgery between 1972 and 1993 were reviewed. Median follow-up time was 4.3 years (ran ge, 1.1-16.8 years). A group of potential prognostic factors was evalu ated, including age at diagnosis, sex, initial tumor presentation (pri mary vs. recurrent), grade, T-stage, direct tumor extension, tumor dep th, duration of treatment, and radiation dose. Results: The subset of angiosarcomas (11 out of 57 patients) had a considerably adverse effec t on treatment outcome for the total group of sarcomas, with actuarial 5-year overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FDM) rates being 31%, 24%, and 42%, respecti vely. In contrast, for the remaining 46 patients with other histopatho logical tumor types, OS, LRC, and FDM rates were significantly higher (74%, 69%, and 83%, respectively). For this group of patients, signifi cant prognostic factors identified by uni- and multivariate analysis i ncluded tumor grade as a predictor of OS and T-stage as a predictor of LRC (p less than or equal to 0.050). Those patients who experienced a locoregional recurrence were at a significantly increased risk of dyi ng (p = 0.004 in a multivariate model). All 17 patients without direct tumor extension to neurovascular structures, bone, contiguous organs, or skin remained free from distant failure. In contrast, 27% of 29 pa tients with direct extension had developed distant metastases at 5 yea rs. In multivariate analysis, the absence of direct extension was a po sitive predictor of FDM (p = 0.007) and of OS (p = 0.034). Conclusions : 1) Angiosarcomas of the head and neck have a considerably poorer pro gnosis than other soft tissue sarcomas of this site. 2) In addition to tumor grade and size, direct tumor extension may be a useful addition al staging parameter. 3) High rates of locoregional failure in the hea d and neck area, a potential cause of morbidity and death, indicate a need for improved treatment strategies.