title: Adjuvant therapies utilization pattern and survival outcomes in high-grade head and neck soft tissue sarcoma; a population based study.
abstract: Head and neck soft tissue sarcoma (HNSTS) is a distinct entity within the soft tissue sarcoma group and the evidence supporting treatment options for this disease is poorly defined. Using the National Cancer Database, this study aims to reveal adjuvant therapy utilization patterns and their outcomes.
  
  
  
  HNSTS patients constituted 6.5% of all sarcoma patients and the analysis was limited to non-metastatic patients who underwent resection between 2004 and 2012. Chi-square test assessed the distribution of demographic, tumor and treatment variables in the treatment subgroups. Kaplan-Meier method estimated overall survival and proportional hazards model estimated survival hazard ratios for prognostic factors including age, comorbidity, gender, race, size, grade, margin status, histology, chemotherapy administration and radiotherapy technique/dose.
  
  
  
  The cohort included 2493 patients with a median age of 62years. Adjuvant therapies were more frequently delivered in high-grade, large tumors and with positive surgical margins. Limiting the analysis to 788 high-grade HNSTS patients, adjunctive radiotherapy improved 5-year survival from 44% (95% confidence interval (CI): 38-50) to 49% (CI: 43-55); reducing mortality hazards ratio by 24% (p<0.001). On multivariate analysis, older age, positive surgical margins and large tumor size were significant predictors of poor survival. These findings were consistent after propensity score analysis.
  
  
  
  Our analysis suggests that adjuvant radiotherapy is associated with improved survival in high-grade HNSTS. Higher dose and precise technique did not accentuate this benefit; however, further studies are needed to refine the treatment strategies, including the role of chemotherapy in the management of this rare disease.
authors.affiliation: Department of Radiation Oncology, Rutgers, the State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Radiation Oncology, Rutgers, the State University of New Jersey, New Jersey Medical School, Newark, NJ, USA. Electronic address: omar.mahmoud@rutgers.edu.
authors.forename: Omar
authors.initials: O
authors.lastname: Mahmoud
authors.affiliation: Department of Radiation Oncology, Rutgers, the State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Beck
authors.affiliation: Department of Otolaryngology- Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Kalyoussef
authors.affiliation: Department of Otolaryngology- Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Chan Park
authors.affiliation: Department of Otolaryngology- Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.affiliation: Department of Radiation Oncology, Rutgers, the State University of New Jersey, Cancer Institute of New Jersey, New Brunswick, NJ, USA; Department of Radiation Oncology, Rutgers, the State University of New Jersey, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Sung
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, University of Miami- Miller, School of Medicine, Miami, Fl, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Samuels
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000532:radiotherapy*; D016019:Survival Analysis
keywords: Adjuvant chemotherapy; Adjuvant radiotherapy; Head and neck soft tissue sarcoma; Survival outcomes