Survival and Margin Status in Head and Neck Radiation-Induced Sarcomas and De Novo Sarcomas

Objective: To describe histologic subtypes and oncologic outcomes among patients with radiation-induced and de novo sarcomas of the head and neck. Study Design: Retrospective case series with chart review. Setting: Tertiary academic center. Subject and Methods: In total, 166 adult patients with sarcoma of the head and neck treated from January 1, 1985, to January 1, 2010, were included. Tumors were characterized as radiation induced (15.1%) vs de novo sarcomas (84.9%). Clinical and tumor characteristics were compared. The primary outcomes were overall survival (OS) and disease-specific survival (DSS). Results: Radiation-induced sarcomas were more likely to be high grade (P =.006) and advanced stage (P =.03). Chondrosarcoma was more common in de novo tumors (P =.02) while leiomyosarcoma (P =.01), sarcoma not otherwise specified (P =.02), and undifferentiated pleomorphic sarcoma (P <.001) were more common in radiation-induced sarcomas. Radiation-induced sarcomas were associated with statistically significantly worse DSS (P =.019) and OS (P =.005) compared with de novo sarcomas, but when only high-grade soft tissue sarcomas were analyzed, neither DSS (P =.48) nor OS (P =.29) differed. Margin status was a significant predictor of survival as both R0 and R1 resections correlated with statistically better DSS and OS compared with R2 (P <.001) resections and patients treated with radiation therapy/chemoradiation therapy alone (P =.005). Conclusion: Radiation-induced sarcomas of the head and neck correlate with worse survival compared with de novo tumors; however, when controlling for tumor grade and resection status, there is no statistically significant difference in observed outcomes.