title: Radiotherapy following gross total resection of adult soft tissue sarcoma of the head and neck.
abstract: OBJECTIVE
  This study reports the outcomes of adults with soft tissue sarcoma (STS) of the head and neck following resection and postoperative radiotherapy (RT), and provides a framework for explaining the issues that radiation oncologists must understand to manage patients with this diverse group of tumors.
  
  
  METHODS
  Twenty-four patients met the following inclusion criteria of this study: age ≥19 years, head or neck primary site, STS, with the exception of rhabdomyosarcoma, Ewing, or angiosarcoma variants, and curative-attempt treatment with gross total tumor resection followed by RT.
  
  
  RESULTS
  All patients underwent gross total tumor resection followed by adjuvant RT at our institution during the 28-year period between June 1, 1981, and December 31, 2009. This is a mature study with a median follow-up of 11 years (range, 0.6-27 years). No patient was lost to follow-up. All recurrences were at the primary site. No patient developed an isolated regional or distant recurrence. No patient developed synchronous nodal or distant recurrences at the time of local recurrence. Half of the recurrences presented within 1 year of completing RT, but there were 2 cases where we did not detect recurrence until years 6 and 8 after RT. No recurrence was successfully salvaged. The actuarial rate of local control and relapse-free survival was 83% (95% CI [confidence interval], 63%-94%) at 5 years and 73% (95% CI, 51%-87%) at 10 years. The incidence of moderate to severe treatment complications was 4%.
  
  
  CONCLUSIONS
  Our series documents that gross total resection followed by RT cures most patients (75%) with the most common types of STS of the head and neck. All recurrences were local, meaning near the primary site in tissue that received the full RT prescription dose. For this reason, modifying the approach to treatment of the primary tumor site is the only strategy that will meaningfully improve outcomes for this group of patients.
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Daniel
authors.initials: D
authors.lastname: Trifiletti
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida. Electronic address: amdurr@shands.ufl.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Roi
authors.initials: R
authors.lastname: Dagan
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida; Department of Otolaryngology, University of Florida, Gainesville, Florida.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Indelicato
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida; Department of Otolaryngology, University of Florida, Gainesville, Florida.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Kirwan
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Anamaria R
authors.initials: AR
authors.lastname: Yeung
authors.affiliation: University of Florida Proton Therapy Institute, Jacksonville, Florida.
authors.forename: John W
authors.initials: JW
authors.lastname: Werning
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, Florida.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris