title: Combined chemoradiation for head and neck region myxofibrosarcoma of the maxillary sinus.
abstract: OBJECTIVE
  Adult sarcomas of the head and neck region (HNSs) are considered a rare clinicopathological entity. They account for only 2-15% of all adult sarcomas and for less than 1% of all head and neck malignancies. The preferred initial treatment option is wide surgical excision. Whenever surgery is considered infeasible, a frontline combined-modality approach including radiotherapy and chemotherapy might be proposed. We here report on a case of localized sarcoma of the maxillary sinus treated with induction chemotherapy and subsequent intensity-modulated radiation therapy (IMRT), achieving a persistent complete remission status.
  
  
  METHODS
  A 66-year-old man was referred to our institution hospital for left-sided facial pain with swollen left cheek and ipsilateral facial palsy. Magnetic resonance imaging showed a mass within the left maxillary sinus extending to the orbital floor and adjacent alveolar bones. Histological examination of the biopsy specimen demonstrated a myxofibrosarcoma. The patient underwent induction chemotherapy with gemcitabine 900 mg/m2 (days 1-8) and taxotere 80 mg/m2 every 3 weeks for 3 cycles and sequential simultaneous integrated boost (SIB) IMRT up to a total dose of 70 Gy/35 fractions to the macroscopic disease with 59.5 Gy/35 fractions to the level IB-II lymph nodes in the left neck.
  
  
  RESULTS
  Treatment was well tolerated with mild acute toxicity. Complete remission was achieved at restaging MRI 6 months after the end of the combined modality approach. The patient remains in complete, unmaintained clinical and instrumental complete remission 18 months after treatment, with no late side effects.
  
  
  CONCLUSIONS
  Combination therapy with induction chemotherapy and sequential SIB-IMRT could therefore be a promising modality for head and neck sarcomas, allowing for simultaneous tumor control and normal tissue sparing.
authors.affiliation: Department of Radiation Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea, Italy. domecante@yahoo.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Cante
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.forename: Piera
authors.initials: P
authors.lastname: Sciacero
authors.forename: Giuseppe Franco
authors.initials: GF
authors.lastname: Girelli
authors.forename: Valeria
authors.initials: V
authors.lastname: Casanova Borca
authors.forename: Massimo
authors.initials: M
authors.lastname: Pasquino
authors.forename: Santi
authors.initials: S
authors.lastname: Tofani
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Bombaci
authors.forename: Fernanda
authors.initials: F
authors.lastname: Migliaccio
authors.forename: Annamaria
authors.initials: A
authors.lastname: Marra
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: La Porta
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D019583:Dose Fractionation, Radiation; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D051677:Histiocytoma, Malignant Fibrous / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D000093542:Gemcitabine