Malignant peripheral nerve sheath tumors of the head and neck: Demographics, clinicopathologic features, management, and treatment outcomes

Objectives: To determine the epidemiology and prognostic indicators in patients with malignant peripheral nerve sheath tumors (MPNST) of the head and neck. Materials and methods: The surveillance, epidemiology, and end results registry was reviewed for patients with head and neck MPNST from 1973 to 2011. Study variables included age, sex, race, tumor size, stage at presentation, and treatment modality. Results: There were 374 cases of head and neck MPNST identified. Mean age at diagnosis was 50.7 years; 60.2% of patients were male and 82.6% were white. After diagnosis, 38.8% of patients underwent surgery and radiation therapy and 48.1% underwent surgery alone. Kaplan-Meier analysis demonstrated overall (OS) and disease-specific survival (DSS) of 51% and 67% at 5 years. Multivariate Cox regression analysis showed that age (p = 0.030), stage (p = 0.002), surgery (p = 0.037), and size (p < 0.001) were predictors of OS, while stage (p < 0.001) and size (p < 0.001) were predictors of DSS. For stage I/II cancers, surgery (p = 0.011) and size (p = 0.010) were predictors of OS, and size (p = 0.001) predicted DSS. For stage III/ IV cancers, both radiotherapy (p = 0.024, p = 0.009) and size (p = 0.001, p = 0.001) predicted OS and DSS. For tumors 65 cm, stage (p = 0.031) predicted DSS. For tumors > 5 cm, male gender (p = 0.005), stage (p = 0.001), surgery (p = 0.003), and radiotherapy (p = 0.050) were determinants of OS, and male gender (p = 0.022), stage (p < 0.001), and radiotherapy (p = 0.002) were determinants of DSS. Conclusion: Surgical resection confers survival benefit in patients with early stage MPNST, while radiotherapy improves survival in cases with metastatic disease. Surgery and radiotherapy are prognostically important in patients with tumors >5 cm. (C) 2015 Elsevier Ltd. All rights reserved.