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Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database

2019; Wiley; Volume: 41; Issue: 6 Linguagem: Inglês

10.1002/hed.25619

1097-0347

Richard B. Cannon, Amanda Kull, Patrick S. Carpenter, Sam Francis, Luke Buchmann, Marcus M. Monroe, Shane Lloyd, Ying J. Hitchcock, Donald M. Cannon, John R. Weis, Jeffrey Houlton, Jason P. Hunt,

Bone Tumor Diagnosis and Treatments

Abstract Background Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. Methods Patients ( n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin. Results Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. Conclusion PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.