AN ASSESSMENT OF PROGNOSTIC FACTORS IN SOFT-TISSUE SARCOMA OF THE HEAD AND NECK

Objective: This study evaluates the outcome, patterns of failure, and prognostic factors in head and neck soft-tissue sarcoma in the adult. Design: A retrospective evaluation of 73 patients treated recently for this rare disease. The minimum follow-up for all patients was 3 years with the living patients having a mean follow-up of 4.6 years. Setting: All patients were treated between January 1980 and December 1988, at the Princess Margaret Hospital-Ontario Cancer Institute, Toronto, the major sarcoma referral center for a population in excess of 3 million. Patients or Participants and Interventions: Fifty-two patients were treated with curative intent: 10 by surgery without radiotherapy and 42 with surgery and radiotherapy. Twelve patients received adjuvant chemotherapy. Outcome Measures: Five-year cause-specific survival, local relapse, and distant failure rates were calculated by the product limit method. Comparisons between survival curves were carried out by the log-rank statistic and Cox regression analysis was performed to assess the influence of prognostic factors. Results: The 5-year cause-specific survival was 62%, with a local relapse rate of 41% and distant relapse rate of 31%. Extension to adjacent structures, high grade, and large lesion size were associated with poorer survival. Gross residual tumor also was associated with high local failure (75% failure) despite the addition of radiation therapy. Those with clear surgical margins or only microscopic involvement fared much more favorably and had similar local control races (26% and 30% failure, respectively) provided adjuvant radiotherapy was given. However, 68% of patients dying as a result of their sarcoma had uncontrolled local disease because of the high incidence (27%) of gross residuum following surgery in this series. Conclusions: This series highlights the absolute necessity for resection of all overt disease with planned adjunctive radiotherapy and appropriate reconstruction in most cases. This is achieved more easily in the setting of a specialized sarcoma treatment unit.