Combined chemoradiation for head and neck region myxofibrosarcoma of the maxillary sinus. Issue 2 (March 2013)

• Record Type: Journal Article
• Authors: Cante, Domenico; Franco, Pierfrancesco; Sciacero, Piera; Girelli, Giuseppe Franco; Borca, Valeria Casanova; Pasquino, Massimo; Tofani, Santi; Bombaci, Sebastiano; Migliaccio, Fernanda; Marra, Annamaria; Numico, Gianmauro; La Porta, Maria Rosa; Ricardi, Umberto
• Is Part Of: Tumori. Volume 99:Issue 2(2013)
• Page Start: e80
• Page End: e83
• Publication Date: 2013-03
• Subjects: head and neck sarcoma -- myxofibrosarcoma -- radiotherapy -- combined modality -- IMRT -- chemotherapy; Cancer -- Periodicals; 616.994
• DOI: 10.1177/030089161309900235
• Languages: English
• ISSNs: 0300-8916

Abstract

Aims and background: Adult sarcomas of the head and neck region (HNSs) are considered a rare clinicopathological entity. They account for only 2–15% of all adult sarcomas and for less than 1% of all head and neck malignancies. The preferred initial treatment option is wide surgical excision. Whenever surgery is considered infeasible, a frontline combined-modality approach including radiotherapy and chemotherapy might be proposed. We here report on a case of localized sarcoma of the maxillary sinus treated with induction chemotherapy and subsequent intensity-modulated radiation therapy (IMRT), achieving a persistent complete remission status. Methods: A 66-year-old man was referred to our institution hospital for left-sided facial pain with swollen left cheek and ipsilateral facial palsy. Magnetic resonance imaging showed a mass within the left maxillary sinus extending to the orbital floor and adjacent alveolar bones. Histological examination of the biopsy specimen demonstrated a myxofibrosarcoma. The patient underwent induction chemotherapy with gemcitabine 900 mg/m 2 (days 1–8) and taxotere 80 mg/m 2 every 3 weeks for 3 cycles and sequential simultaneous integrated boost (SIB) IMRT up to a total dose of 70 Gy/35 fractions to the macroscopic disease with 59.5 Gy/35 fractions to the level IB-II lymph nodes in the left neck. Results: Treatment was well tolerated with mild acute toxicity. Complete remission was achieved at restaging MRI 6 months after the end of the combined modality approach. The patient remains in complete, unmaintained clinical and instrumental complete remission 18 months after treatment, with no late side effects. Conclusion: Combination therapy with induction chemotherapy and sequential SIB-IMRT could therefore be a promising modality for head and neck sarcomas, allowing for simultaneous tumor control and normal tissue sparing.