GP4d - Long-Term Outcomes in Pediatric Head and Neck Sarcomas: A Retrospective Analysis

Abstract:

Introduction: Sarcomas of the head and neck are relatively rare in the pediatric population. They are a heterogeneous group of malignancies, posing both diagnostic and therapeutic challenges. Prognostic indicators for long-term outcomes including local recurrence and metastasis have yet to be established in this patient population. In this study, we describe long-term outcomes in children with head and neck sarcoma (HNS).

Methods: A retrospective review was conducted of patients with HNS treated at a tertiary children’s hospital from 2006 to 2024. Patients who had a follow-up time of less than 1 year were excluded. Demographic data, tumor characteristics, and treatment modality were collected. Primary outcome measures included secondary surgical resection, incidence of local recurrence, occurrence of metastasis, and associated morbidity. Statistical analyses were performed using Pearson’s chi-squared test, independent samples t-test, and Wilcoxon-sign rank test. Multivariable logistic regression was also performed to assess the predictive value of individual determinants on primary outcome measures.

Results: A total of 61 children with HNS met inclusion criteria. Of them, 35 patients (57.3%) had rhabdomyosarcoma, 10 patients (16.4%) had fibrosarcoma, and 7 patients (11.5%) had osteosarcoma. The remaining 9 patients had Ewing sarcoma (6.6%), epithelioid sarcoma (4.9%), or synovial sarcoma (1.6%). The median age at diagnosis was 7.4 years [3.1-14.8] and the average follow-up time was 6.6 years. Mortality during the study period was 26.2%. Patients with rhabdomyosarcoma were 2 times less likely to require surgical re-resection compared to all other HNS types (P = .03). Other protective factors against surgical re-resection were R0 margins at initial surgery (P < .001) and adjuvant chemotherapy (P = .019). In terms of recurrence rates, patients with histologic grade G1 tumors were 9 times less likely to have local recurrence compared to higher grade tumors (P = .015). Additionally, patients without lymph node invasion were 2 times less likely to have local recurrence (P = .03). Tumor size was not correlated with local recurrence (P = 0.136). In terms of metastasis, tumor size less than 2 cm was 4 times less likely to be associated with metastatic disease (P < .001). Finally, patients with osteosarcoma and high histologic grade G3-G4 tumors were more likely to develop metastases (P = .011 and P = .014, respectively). Finally, morbidity rates were significantly lower in patients with no metastatic disease (P = .006) and who were surgically resected (P = .001).

Conclusion: In this study, we identified critical factors influencing local and distant recurrence in pediatric patients with HNS. Adjuvant chemotherapy and small tumor size were both associated with a lower likelihood of surgical re-resection and distant metastasis, respectively. High histologic grade and lymph node involvement were significant predictors of local recurrence. These findings highlight the importance of early diagnosis and tailored therapeutic strategies to enhance long-term survivability in this vulnerable population.