title: Sarcomatoid carcinoma in head and neck: a review of 30 years of experience--clinical outcomes and reconstructive results.
abstract: Sarcomatoid carcinoma (SaCa) is a rare variant of squamous cell carcinoma (SCC) with sarcomatoid features. This study investigated the clinical presentation and outcomes of head and neck SaCa. In addition, reconstructive outcome for a subset of patients was also evaluated.
  Seventy-eight SaCa cases including 72 men and 6 women were identified from 13,777 head and neck SCC cases. Clinical outcomes were evaluated based on locoregional control, distant metastases, and multivariate analyses. Reconstructive outcome was evaluated by flap survival rate.
  
  
  RESULTS
  Of the 78 cases, 71% (55) of cases were located in the oral mucosa; 64% (50) of patients were classified as T3 or T4 at the time of diagnosis. The 5-year survival was only 16%. Multivariate analysis revealed better outcomes only when the patient had a history of previous SCC. Forty-five patients underwent flap reconstruction, with 98% flap survival rate but the functional result varied because of the inevitable adjuvant radiotherapy and advanced stage of tumor.
  
  
  CONCLUSIONS
  Sarcomatoid carcinoma is a different entity from the conventional SCC of the head and neck. Sarcomatoid carcinoma carries a poorer prognosis despite aggressive surgical intervention and concurrent adjuvant therapies. It remains a great challenge for clinical oncologists, and the optimal treatment strategy requires further studies. Free flap is still preferred for defect reconstruction but the design should be simplified to avoid complications.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou; †Chang Gung University College of Medicine, Taoyuan; ‡Department of Pathology, and §Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Chang
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Kao
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.forename: John Wen-Cheng
authors.initials: JW
authors.lastname: Chang
authors.forename: Ming-Mo
authors.initials: MM
authors.lastname: Hou
authors.forename: Wee Leon
authors.initials: WL
authors.lastname: Lam
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D064827:Myocutaneous Flap; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D013524:Surgical Flaps