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The UCLA Experience

Rufus J. Mark, MD; Joel A. Sercarz, MD; Luu Tran, MD; Michael Selch, MD; Thomas C. Calcaterra, MD

Arch Otolaryngol Head Neck Surg. 1991;117(4):396-401.

Abstract
• Between 1955 and 1987, twenty-nine patients with the diagnosis of fibrosarcoma of the head and neck were seen at the UCLA Medical Center. Follow-up ranged from 15 to 192 months, with a median of 66 months. Absolute 5-year survival was 62% (13/21). Five of 17 patients treated initially with surgery alone achieved local control and long-term survival. All five had low-grade lesions. Five patients received postoperative radiation therapy because of positive surgical margins. Three were rendered disease free, and all had low-grade lesions. Radiation therapy was used as primary treatment in six patients, four of whom received additional chemotherapy. Of these six, two are disease free with longer than 5-year follow-up. Surgery with and without adjuvant therapy successfully salvaged 42% (5/12) of the patients with local recurrence. Eighty percent (12/15) of the patients with low-grade lesions were ultimately rendered disease free vs only 8% (1/12) of the patients with high-grade histologic features. Seventy-two percent (13/18) of the patients with local recurrence were known to have positive surgical margins. Sixty-eight percent (13/19) of the patients with recurrent disease had high-grade lesions and/or tumor size larger than 5 cm. Tumor grade is the most important prognostic factor followed by tumor size and surgical margin status. Patients with low-grade lesions and adequate surgical margins are treated well with surgery alone. Patients with high-grade lesions or positive surgical margins should receive adjuvant treatment.

(Arch Otolaryngol Head Neck Surg. 1991; 117:396-401)

Author Affiliations
From the Departments of Radiation Oncology (Drs Mark, Tran, and Selch), and Division of Head and Neck Surgery (Drs Sercarz and Calcaterra), UCLA Medical Center.

Footnotes
Accepted for publication November 26, 1990.

Presented at the 32nd Annual Meeting of the American Society for Head and Neck Surgery, Palm Beach, Fla, May 1, 1990.

Reprint requests to Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA 90024 (Dr Mark).

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