Locoregional treatment for adult soft tissue sarcomas of the head and neck: An institutional review

PURPOSE: The purpose of this study was to review treatment results for primary soft tissue sarcomas of the head and neck in order to determine prognostic factors. PATIENTS AND METHODS: From 1970 to 2000, 44 adult patients were diagnosed with a biopsy-proven, nonmetastatic primary soft tissue sarcoma in a head and neck subsite; were treated with curative intent; and had adequate follow-up and records for our review. Patients with extraosseous Ewing's sarcoma, Kaposi's sarcoma, rhabdomyosarcoma, dermatofibrosarcoma protuberans, and desmoid tumor were excluded. The most common tumor histologies included malignant fibrous histiocytoma (15 patients), angiosarcoma (nine patients), fibrosarcoma (six patients), and leiomyosarcoma (six patients). RESULTS: The median overall survival for all patients was 79 months. The actuarial 5-year local control for all patients was 55% and was highly correlated with the extent of surgical excision: 25% for subtotal resection/debulking, 65% for wide local excision, and 100% for radical excision. Local control at 5 years was 60% for patients treated with both surgery and radiotherapy, 54% for those treated with surgery alone, and 43% for those treated with radiotherapy alone. Adjuvant radiotherapy significantly improved the local control rates (from 25% to 54%) for patients with close (<2 mm) or positive surgical margins. Of 14 patients with locoregional failure in whom salvage was attempted, nine (64%) were rendered disease free. CONCLUSIONS: Multimodality therapy with both surgery and radiotherapy improves local control, particularly in patients with close or positive surgical margins. Aggressive attempts at salvage therapy for locoregional failures are warranted and frequently produce long-term disease control.