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. 2018 Oct;79(5):437-444.
doi: 10.1055/s-0037-1615816. Epub 2018 Jan 9.

Impact of Surgical Margin in Skull Base Surgery for Head and Neck Sarcomas

Kenya Kobayashi  1 , Fumihiko Matsumoto  1 , Yasuji Miyakita  2 , Taisuke Mori  3 , Tatsunori Shimoi  4 , Naoya Murakami  5 , Akihiko Yoshida  3 , Ayumu Arakawa  6 , Go Omura  1 , Masahiko Fukasawa  1 , Yoshifumi Matsumoto  1 , Satoko Matsumura  1 , Jun Itami  5 , Yoshitaka Narita  2 , Seiichi Yoshimoto  1
Affiliations

Impact of Surgical Margin in Skull Base Surgery for Head and Neck Sarcomas

Kenya Kobayashi et al. J Neurol Surg B Skull Base. 2018 Oct.

Abstract

Objective This study aimed to determine the adequate resection margin in skull base surgery for head and neck sarcoma. Design We retrospectively reviewed 22 sarcomas with skull base invasion. Induction chemotherapy, followed by surgery and postoperative radiotherapy and adjuvant chemotherapy, was performed in 18 patients with chemosensitive sarcomas, and surgery with or without postoperative radiotherapy was performed in four patients with chemoresistant sarcomas. Radical resection was performed in patients with chemosensitive sarcomas with a poor response to induction chemotherapy and in patients with chemoresistant sarcomas. Conservative resection with close surgical margin was performed in patients with chemosensitive sarcomas with a good response to induction chemotherapy. Setting and Participants This single-centered retrospective study included patients from the National Cancer Center Hospital, Japan. Results The response to induction chemotherapy was significantly associated with the 3-year local control rate (LCR; good response versus poor response: 100% versus 63%, p = 0.048). Patients with a good response to chemotherapy had a favorable local prognosis even when the local therapy was conservative resection. In radical skull base surgery, patients whose surgical margins were classified as "wide margin positive" had significantly poorer 3-year LCR than did patients with "margin negative" or "micro margin positive" margins (25% versus 83%, p = 0.014). Conclusion Conservative resection with close surgical margins might be acceptable for chemosensitive sarcomas with a good response to chemotherapy. Resection margin status was an important predictive factor for local recurrence after radical skull base surgery. Microscopic microresidual tumor might be controlled by postoperative treatment.

Keywords: chemosensitivity; head and neck sarcoma; induction chemotherapy; skull base surgery; surgical margin.

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Conflict of interest statement

Conflicts of Interest The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Treatment strategy. The main treatment strategies for the two groups are displayed. RMS, rhabdomyosarcoma; VDC, vincristine, dactinomycin, and cyclophosphamide; ES, Ewing sarcoma; VDC/IE, vincristine, doxorubicin and cyclophosphamide/ifosfamide and etoposide; RT, radiotherapy.
Fig. 2
Fig. 2
Case presentations. ( A ) A 25-year-old man with a nasal cavity primary rhabdomyosarcoma. The tumor invaded the dura mater. He underwent four cycles of VAC chemotherapy and achieved a clinical complete response. A conservative resection was performed in this case. ( B ) A 25-year-old man with an ethmoid sinus primary rhabdomyosarcoma. He underwent four cycles of VAC chemotherapy, and the tumor response revealed a stable disease. A radical resection with craniotomy was performed in this case. ( C ) A 21-year-old woman with a nasopharynx primary rhabdomyosarcoma. The tumor invaded the infratemporal fossa; however, computed tomography images reported absence of cranial base bony erosion. She underwent four cycles of VAC chemotherapy, and the tumor response was partial. A radical resection without craniotomy by the mandibular swing approach was performed in this case.
Fig. 3
Fig. 3
Surgery performed. The operative procedures are summarized.
Fig. 4
Fig. 4
( A ) Local control rates of the three groups. Patients with a good response to induction chemotherapy had significantly better 3-year local control rate than patients with a poor response to induction chemotherapy. ( B ) Overall survival of the three groups. Chemosensitivity was not associated with overall survival.
See this image and copyright information in PMC

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