The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian sarcoma research and Clinical Collaboration (CanSaRCC) study

Sharon Tzelnick; Hagit Peretz Soroka; Najifah Tasnim; Ralph W Gilbert; Jonathan C Irish; David P Goldstein; Dale Brown; Patrick Gullane; Douglas B Chepeha; Christopher M K L Yao; Axel Sahovaler; Ian J Witterick; Eric Monteiro; Joel Davies; Shao Hui Huang; Brian O'Sullivan; Ezra Hahn; Ali Hosni; Albiruni Abdul Razak; Abha A Gupta; John R de Almeida

doi:10.1016/j.oraloncology.2023.106495

The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian sarcoma research and Clinical Collaboration (CanSaRCC) study

Oral Oncol. 2023 Oct:145:106495. doi: 10.1016/j.oraloncology.2023.106495. Epub 2023 Jul 19.

Authors

Sharon Tzelnick¹, Hagit Peretz Soroka², Najifah Tasnim³, Ralph W Gilbert¹, Jonathan C Irish⁴, David P Goldstein¹, Dale Brown¹, Patrick Gullane¹, Douglas B Chepeha¹, Christopher M K L Yao¹, Axel Sahovaler¹, Ian J Witterick⁵, Eric Monteiro⁵, Joel Davies⁵, Shao Hui Huang⁶, Brian O'Sullivan⁶, Ezra Hahn⁶, Ali Hosni⁶, Albiruni Abdul Razak⁷, Abha A Gupta⁸, John R de Almeida⁹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
² Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada.
³ CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
⁵ Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada.
⁶ Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada.
⁷ Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
⁸ Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Ontario, Canada; Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada.
⁹ Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Electronic address: john.dealmeida@uhn.ca.

PMID: 37478572
DOI: 10.1016/j.oraloncology.2023.106495

Abstract

Objective: The aim of the study is to describe the factors that influence outcome in adults with head and neck osteosarcoma (HNO) with a specific focus on the margin status.

Methods: Patients with a diagnosis of HNO between the years 1996-2021 were reviewed from the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Database. Baseline characteristics, pathology, treatment, and outcomes were analyzed. Univariable (UVA) and multivariable (MVA) Cox regression models were performed. 5-year locoregional control rate and overall survival (OS) were estimated using Kaplan-Meier method and Log-Rank test.

Results: Of 50 patients with a median age of 40 years (range 16-80), 27 (54%) were male. HNO commonly involved the mandible (n = 21, 42%) followed by maxilla (n = 15, 30%). Thirteen (33.3%) had low-intermediate grade and 26 (66.6%) had high grade tumors. Three patients (6%) had negative resection margins (>5 mm), 24 (48%) had close margins (1-5 mm), 15 (30%) had positive margins (<1mm) and 7 (16%) had unknown margin status. In total, 39 (78%) received chemotherapy - 22 (44%) received neoadjuvant chemotherapy while 17 (34%) received adjuvant chemotherapy. A total of 12 (24%) patients received radiotherapy, of whom 8 (16%) had adjuvant and 3 (6%) had neo-adjuvant. Median follow-up time was 6.3 years (range 0.26-24.9). Disease recurred in 21 patients (42%), of whom 15 (30%) had local recurrence only, 4 (8%) had distant metastasis, and 2 (4%) had both local and distant recurrence. 5-year locoregional control rate and OS was 62% and 79.2% respectively. Resection margins <3 mm was associated with lower 5 years OS and locoregional control rate (Log-Rank p = 0.02, p = 0.01 respectively).

Conclusion: Osteosarcomas of the head and neck are rare and local recurrence remains a concern. Surgical resection with negative resection margins may improve survival, and a 3 mm resection margin threshold may optimize survival. Radiotherapy and/or chemotherapy should be considered in a multidisciplinary setting based on risk-features.

Keywords: Disease outcome; Head and neck; Margins status; Osteosarcoma.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Bone Neoplasms* / pathology
Canada / epidemiology
Female
Humans
Male
Margins of Excision
Middle Aged
Neoplasm Recurrence, Local / pathology
Osteosarcoma* / pathology
Retrospective Studies
Sarcoma* / pathology
Soft Tissue Neoplasms*
Young Adult