Clinico-epidemiological and treatment factors impact on survival in Egyptian patients with head and neck sarcoma: a retrospective case-series analysis.
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BACKGROUND: Head and neck sarcomas are very rare accounting for about 1% of head and neck malignancies and 5% of sarcomas. Outcomes have historically been worse in this group compared to other sarcomas, due to anatomical constraints that make complete surgical removal difficult and increased local relapse rate. Surgery remains the main intervention although the data suggest the role of chemotherapy and irradiation as treatment options. METHODOLOGY: and Design. Data of patients diagnosed with head and neck sarcoma were retrospectively collected. Clinicopathologic characteristics and patients' management were reviewed. Time to relapse (TTR) includes both time to local relapse (TTLR) and time to systemic relapse (TTSR). Overall survival (OS), TTLR and TTSR were calculated with Kaplan Mayer analysis using log rank test. RESULTS: Twenty-four patients were retrospectively identified. Mean age was 37.7 years (range 17-80) with female gender predominance (62.5%). Rhabdomyosarcoma and osteosarcoma were the most common types (16.7%). At presentation, 23 patients showed localized disease (95.8%), while one patient was metastatic to the bone. Surgery was the primary treatment in 83.3% patients with different surgical margin status (R0 in 6/20, R1 in 11/20 and R2 in 3/20 patients), while 4/24 patients were not operated. Radiotherapy was applied as adjuvant treatment in 9 patients, as definitive in 2 and as palliative in one patient. Chemotherapy was administered in neoadjuvant/ adjuvant settings in 8 patients. Median follow-up was 31 months. Mean TTR for all surgically resected population was 39.8 months. Locally relapsed patients were 35% with mean TTLR 43.2 months while 15% of patients developed systemic relapse with mean TTSR 55 months. Mean OS of all studied patients was 48 months. CONCLUSION: Head and neck sarcomas are rare challenging malignancies due to anatomical constrain, with only 20% achieving R0 surgical resection and > 30% suffering of local relapse after complete surgical resection.