Assessment of Prognostic Factors and Adjuvant Treatment Modalities in Adult Head and Neck Soft Tissue Sarcoma Patients Treated With Upfront Surgery

Baran Akagündüz; Tugba Akin Telli; Sema Sezgin Goksu; Hasan Cagri Yildirim; Muhammet Ozer; Sabin Göktaş Aydin; Neslihan Ozyurt; Cengiz Karacin; Semra Paydas; Mutlu Dogan

doi:10.7759/cureus.13324

Assessment of Prognostic Factors and Adjuvant Treatment Modalities in Adult Head and Neck Soft Tissue Sarcoma Patients Treated With Upfront Surgery

Cureus. 2021 Feb 13;13(2):e13324. doi: 10.7759/cureus.13324.

Authors

Affiliations

¹ Medical Oncology, Erzincan Binali Yıldırım Üniversitesi Mengücek Gazi Hastanesi, Erzincan, TUR.
² Medical Oncology, Marmara University Medical School, Istanbul, TUR.
³ Medical Oncology, Akdeniz University Medical School, Antalya, TUR.
⁴ Medical Oncology, Hacettepe University Medical School, Ankara, TUR.
⁵ Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
⁶ Medical Oncology, Medipol Unıversity Medical School, Istanbul, TUR.
⁷ Medical Oncology, Giresun Research Hospital, Giresun, TUR.
⁸ Oncology, Recep Tayyip Erdoğan University Medical School, Rize, TUR.
⁹ Medical Oncology, Cukurova University Faculty of Medicine, Adana, TUR.
¹⁰ Medical Oncology, Ankara Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR.

Abstract

Objectives Head and neck soft tissue sarcomas (HNSTSs) are a heterogeneous group of rare tumors. Surgical resection with negative margins remains the standard primary treatment for patients with HNSTS. The role of chemotherapy (CT) and radiotherapy (RT) remains controversial. In this multicenter study, we aimed to demonstrate the real-world assessing prognostic factors and the effect of adjuvant treatment modalities in adult patients with HNSTS treated with upfront surgery. Methods We included a total of 47 patients who underwent curative-intent resection of a primary HNSTS between 2000 and 2019. Results The median follow-up was 29 months. The median age of patients was 51 years, and 66% of patients were male. The median relapse-free survival (RFS) of the study population was 31 months (range: 1.0-61.1 months), and the median overall survival (OS) was 115 months (range: 60.8-169.2 months). The univariable analysis revealed that treatment modalities showed a significant impact on RFS (p = 0.021); however, no difference was found in its impact on OS (p = 0.137). R0 resection did not showed impact on RFS (p = 0.130), but a significant association was found with OS (p = 0.004). In multivariable analysis, T stage of the tumor (hazard ratio [HR]: 3.834; 95% CI: 1.631-9.008; p = 0.002) and treatment with surgery and sequential RT and CT (HR: 0.115; 95% CI: 0.035-0.371; p < 0.001) were independent factors associated with RFS. R0 resection was independently associated with OS (HR: 4.902; 95% CI: 1.301-18.465; p = 0.019). Conclusion Our study revealed that R0 resection improved OS, and T3-4 stage of tumor was a negative independent factor for RFS in surgically resected HNSTS patients. The use of sequential CT and RT after resection was associated with a better RFS, which emphasizes the importance of multidisciplinary evaluation of the treatment of HNSTS. Randomized prospective studies are needed.

Keywords: adjuvant chemotherapy; adjuvant radiation therapy; head and neck cancer surgery; head and neck sarcoma; survival analysis.