title: Excellent local control and survival after postoperative or definitive radiation therapy for sarcomas of the head and neck.
abstract: BACKGROUND
  To report our results with postoperative or definitive radiation therapy in head and neck sarcomas.
  
  
  METHODS
  We performed a retrospective analysis of 26 patients suffering from head and neck sarcomas, who received postoperative or definitive radiation therapy between 2003 and 2012. Median age was 64 years (19-88) and 69 % were male. Tumor locations were skull (including skin) in 31 %, paranasal sinus/orbita in 27 % and neck (including pharynx/larynx) in 42 %. Median tumor size was 4.6 cm (1-12 cm). 22 patients (85 %) presented in primary situation. Stage at presentation (UICC 7(th) for soft tissue sarcomas) was as follows: Ia:4 %, IIa:50 %, IIb:15 %, III:31 %. All except one patient suffered from high grade lesions (G2/3 FNCLCC), predominantly angiosarcoma (35 %), MFH (19 %) and synovial sarcoma (15 %). Surgery was performed in 21 pts (81 %), resulting in free margins in 10 (38 %), microscopically positive margins in 6 (23 %) and gross residual disease in 5 (19 %). Median dose to the primary tumor region was 66Gy (45-72Gy) in conventional fractionation, using 3D-CRT in 65 %, IMRT in 27 % and electrons in 8 %. 50 % of the patients also received sequential chemotherapy.
  
  
  RESULTS
  Median follow up was 39 months (8-136). We observed three local recurrences, transferring into estimated 3- and 5-year local control rates of 86 %. One additional patient failed distantly, resulting in 3- and 5-year freedom from treatment failure rates of 82 %. Four patients have deceased, transferring into 3- and 5-year overall survival rates of 88 % and 82 %, respectively. Only two of the four deaths were sarcoma related. Maximum acute toxicity (CTCAE 3.0) was grade 1 in 27 % of the patients, grade 2 in 50 % and grade 3 in 23 %. Severe acute toxicity was mainly represented by mucositis and dysphagia. Maximum late toxicity was grade 1 in 31 %, grade 2 in 15 % and grade 3 in 19 % of the patients. Severe late toxicity included skin ulceration (n = 1), dysphagia with persistent tube dependency (n = 1), persistent sinusitis (n = 1) and hearing loss (n = 2).
  
  
  CONCLUSIONS
  Excellent local control and overall survival rates can be achieved with postoperative or definitive radiation therapy with acceptable acute and late toxicities in patients suffering from sarcomas of the head and neck region.
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Claudia.Andrae@med.uni-muenchen.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Andrä
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Josefine.Rauch@med.uni-muenchen.de.
authors.forename: Josefine
authors.initials: J
authors.lastname: Rauch
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Minglun.Li@med.uni-muenchen.de.
authors.forename: Minglun
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Ute.Ganswindt@med.uni-muenchen.de.
authors.forename: Ute
authors.initials: U
authors.lastname: Ganswindt
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Claus.Belka@med.uni-muenchen.de.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Ladan.Salehebrahimi@med.uni-muenchen.de.
authors.forename: Ladan
authors.initials: L
authors.lastname: Saleh-Ebrahimi
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Hendrik.Ballhausen@med.uni-muenchen.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ballhausen
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Silke.Nachbichler@med.uni-muenchen.de.
authors.forename: Silke Birgit
authors.initials: SB
authors.lastname: Nachbichler
authors.affiliation: Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. Falk.Roeder@med.uni-muenchen.de.|Department of Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Falk.Roeder@med.uni-muenchen.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome; D047368:Tumor Burden