Sarcoma and Cutaneous Tumors
PV QA 2 - Poster Viewing Q&A 2
MO_20_2620 - Long Term Outcomes and Prognostic Factors of Head and Neck Soft Tissue Sarcoma (HNSTS) Treated with Definitive Therapy
Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3
Long Term Outcomes and Prognostic Factors of Head and Neck Soft Tissue Sarcoma (HNSTS) Treated with Definitive Therapy
J. K. Kim1,2, T. Beckham3, S. McBride4, K. M. Alektiar4, N. Riaz3, J. E. Leeman1, D. Spielsinger1, C. Sabol1, T. Brinkman1, T. Waldenberg1, N. Lee3, and C. J. Tsai3; 1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 2Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, 3Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, 4Memorial Sloan Kettering Cancer Center, New York, NY
Purpose/Objective(s): We reviewed long term outcomes of HNSTS patients treated at a tertiary cancer center with definitive intent.
Materials/Methods: The study included adult (>18 yo) patients with biopsy-proven HNSTS treated at our institution between 1990 and 2016. Local progression free survival (LPFS) and overall survival (OS) were evaluated using the Kaplan-Meier method. Chi-square was used to compare the clinicopathologic features between the treatment groups (surgery alone, RT/CRT alone, surgery with RT/CRT) and their impact on LPFS. Cox proportional hazard analysis was used to evaluate associations between survival outcomes and clinical factors.
Results: The cohort consisted of 127 patients with a median age of 53 years (range: 19-86) and 58% male. The most common anatomic site of disease was the oral cavity (35%). 58 (46%) received radiation therapy (RT): 16 were treated in the definitive setting and 42 (33%) received radiation with definitive surgery, and 16 also received concurrent chemoradiation (CRT) (7 definitive CRT and 9 surgery with CRT). 91 patients were treated with definitive surgery, of which 49 were surgery only without RT. After excluding patients without follow-up, we had 104 patients for survival and outcome analysis: 2-year OS and LPFS were 76.9% and 63.0%, respectively. In multivariate analysis, factors associated with worse LPFS included non-white race (HR 3.51, 95%CI 1.47-8.35) and high grade tumors (HR 3.20, 95%CI 1.04-9.83). Compared to patients who received only surgery, those who had definitive RT/CRT (HR 0.18, 95%CI 0.05-0.66) and definitive surgery with RT/CRT (HR 0.23, 95%CI 0.1-0.57) were associated with better LPFS. Patients >60 years of age (HR 2.81, 95% CI 1.34-5.88) and high grade tumors (HR 3.17, 95%CI 1.12-8.95) were associated with worse OS than patients <60 years of age and low/intermediate grade tumors. There was no significant difference in OS between treatment groups (surgery alone, RT/CRT alone, surgery with RT/CRT). In the subset of patients who received definitive surgery, non-white race (HR 3.6, 95%CI 1.5-8.9) was associated with worse LPFS and surgery with RT/CRT (HR 0.25, 95%CI 0.1-0.61) was associated with increased LPFS in comparison to surgery alone; in this same subset, there was no significant difference in OS.
Conclusion: In patients with HNSTS, surgery alone was associated with worse LPFS than RT/CRT alone and surgery with RT/CRT groups. Non-white race and high grade tumors were also associated with decreased LPFS in the main cohort. Factors associated with worse OS included older age (≥60) and high grade tumors. In the surgical subgroup, non-white race and surgery alone were associated with decreased LPFS. There was no difference in OS between treatment groups in both the cohort and the surgical subgroup.
Author Disclosure: J.K. Kim: None. T. Beckham: None. K.M. Alektiar: None. J.E. Leeman: None. D. Spielsinger: None. N. Lee: Consultant; Lily. Advisory Board; Vertex, Pfizer, Merck. C. Tsai: None.