PROGNOSTIC FACTORS IN ADULT SOFT-TISSUE SARCOMAS OF THE HEAD AND NECK

Purpose: The main objectives of this study were (a) to review the trea tment results of primary head and neck soft-tissue sarcoma at our inst itution, (b) to identify important prognostic factors in local control and survival, and (c) to assess the efficacy of salvage therapy. Meth ods and Materials: Sixty-five patients were treated at the University of California, San Francisco, between 1961 and 1993. Seventeen patient s (27%) had low-grade, 10 (15%) had intermediate-grade, and 38 (58%) h ad high-grade sarcomas. Tumors were > 5 cm in 35 patients. Local manag ement consisted of surgery alone in 14 patients (22%), surgery and rad iotherapy in 40 (61%), and radiotherapy alone in 11 (17%) patients. Th e median follow-up was 64 months. Results: The 5-year actuarial local control rate of the entire group was 66%. Tumor size and grade were im portant predictors for local control on multivariate analysis. The act uarial local control rate at 5 years was 92% for T1 vs. 40% for T2 pri maries (p = 0.004), and 80% for Grade 1-2 vs, 48% for Grade 3 tumors ( p = 0.01). None of the patients treated with radiotherapy alone with a dose of 50-65 Gy were controlled locally. Combined radiotherapy and s urgery appeared to yield superior local control compared to surgery al one (77% vs. 59%); however, the difference was not statistically signi ficant. The 5-year actuarial overall and cause-specific survivals were 56% and 60%, respectively, Unfavorable prognostic factors for cause-s pecific survival on multivariate analysis were age > 55 (p = 0.009), h igh tumor grade (p = 0.0002), inadequate surgery (p = 0.008), and posi tive surgical margins (p = 0.0009). In patients who underwent salvage therapy for treatment failure, the 5-year actuarial survival after sal vage treatment was 26%. Conclusion: Tumor size and grade a ere importa nt predictors for local control. Age, grade, adequacy of surgery, and status of surgical margins were significant prognostic factors for sur vival. There was a trend of improved local control with combined surge ry and radiotherapy compared to either modality alone for high-risk pa tients. Radiotherapy alone with doses less than or equal to 65 Gy was insufficient for control of gross disease. Aggressive salvage therapy was worthwhile in patients whose disease was uncontrolled after the in itial treatment. (C) 1997 Elsevier Science Inc.