Neck Sarcomas Research Articles

Determining factors of renal dysfunction during cisplatin chemotherapy.

Cisplatin remains one of the most active antineoplastic treatments used in oncology, being the most prestigious exponent of the golden age in chemotherapy at the end of the 20th century. This chemotherapeutic drug is used for curative or palliative treatments in testicular, ovarian, head and neck neoplasms, sarcomas and lymphomas. The limiting dose adverse effect of cisplatin is nephrotoxicity. The present study aimed to evaluate the magnitude of the damage to renal function and to identify the risk or protective factors in renal toxicity. The retrospective study was performed using 81 consecutive patients who underwent at least three cycles of cisplatin chemotherapy. The results indicate an average decline in glomerular filtration rate (GFR) of 9 ml/min. Women appear to be less by a decline in renal function (a relative decline of GFR of -5% for women compared to -9% for men). The decline in GFR was found to be proportional to age; overweight (not obese) individuals had the best renal function behavior under cisplatin treatment, while the association of anaemia appears to be a risk factor for renal toxicity. The use of cisplatin in oncology in the last years may have decreased, either by using combination chemotherapy instead of monotherapy, or by its displacement by newly discovered treatments (e.g., immunotherapy in lung cancer). Therefore, it is possible that the profile of patients who are exposed to this drug and the duration of exposure have been modified compared to previous studies. The objectives of the present study were to assess the magnitude of the renal function damage during cisplatin treatment and to identify the risk and the protective factors in term of renal toxicity.

Head and neck sarcomas: imaging "pearls" and "mimics".

Sarcomas are rare tumours, which can arise in any location in the head and neck. This review highlights the characteristic features of the commoner subtypes of bone and soft tissue sarcomas (including radiation-induced sarcomas), with emphasis on diagnostic "pearls" and imaging "mimics". This knowledge will help the radiologist formulate a differential diagnosis and expedite referral to a regional sarcoma unit for definitive management.

Pediatric head and neck rhabdomyosarcoma: An analysis of treatment and survival in the United States (1975–2016)

IntroductionRhabdomyosarcoma (RMS) is the most common soft tissue head and neck sarcoma in children. Stringent analysis of survival data is imperative to optimize treatment. MethodsThe National Cancer Database (NCDB, 2004–2016) and the Surveillance, Epidemiology, and End Results Program (SEER, 1975–2016) were queried for patients ages 0–19 with RMS of the head and neck. Survival trends were analyzed using univariable logistic regression and Chi-square pairwise comparisons. Survival by treatment was analyzed using log-rank tests, Kaplan Meier, and multivariable Cox-proportional hazards regression. Results1147 (63.3% age <10 years, 54.3% male) and 459 (71.4% age <10 years, 53.6% male) patients were identified in NCDB and SEER, respectively. In NCDB, embryonal (n = 625, 54.5%) and alveolar (n = 300, 26.2%) were the most common histology and nonparameningeal/non-orbital (n = 634, 55.3%), followed by parameningeal (n = 303, 26.4%) and orbital (n = 210, 18.3%) the most common location. Five-year overall survival (OS) was 70.3% with lower mortality risk for embryonal histology (adjusted HR [aHR] = 0.69, p = 0.0038). Orbital tumors had greatest survival (5-year OS = 92.4%) of all sites, and their mortality risk was higher with chemotherapy and radiation compared to surgery and radiation (aHR = 6.27, p = 0.0302). SEER analysis showed average increased survival by 4% per year (p < 0.0001), but no significant 5-year OS difference when comparing 1976–1980 and 2006–2010 (p = 0.0843). ConclusionsMajor prognostic factors for survival in childhood RMS of the head and neck were embryonal histology, orbital site, extent of disease, and use of SRT for orbital tumors. Larger population studies are required to demonstrate survival differences between treatment modalities for other sites.

HEAD AND NECK SARCOMAS: ANALYSIS OF CLINICOPATHOLOGIC FEATURES AND PROGNOSTIC FACTORS

Objective: The objective of this study was to analyze the demographic, clinicopathologic, treatment, and survival characteristics of head and neck sarcomas diagnosed in a reference center in the Brazilian Northeast. Study Design: This retrospective cohort study reviewed the clinical records of patients with head and neck sarcomas. Epidemiologic data were clinical location, age, gender, histopathological diagnosis, tobacco smoking, alcohol consumption, clinical TNM staging, and treatment. Local recurrence and survival were the outcome variables. Statistical analysis was performed by χ2 test, Fisher exact test, and binary logistic regression analysis. Survival analysis was assessed through the Kaplan-Meier curve. Results: In all, 69 cases were identified. The most common histologic sub-types were rhabdomyosarcoma, dermatofibrosarcoma, and pleomorphic sarcoma. The mean age of the patients at the time of diagnosis was 38.1 years. A total of 31 cases analyzed were deaths due to the neoplastic process, with a mean follow-up rate of 1.63 years. Multivariate analysis performed revealed that anatomic site, modality of treatment, histopathological diagnosis, and stage I disease were associated with specific survival reaching statistical significance. Conclusions: This study demonstrates the impact of important clinicopathologic parameters on overall prognosis of head and neck sarcomas.

Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer

Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. A retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Of the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, -0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (-0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction. Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.

Head and neck sarcomas in adulthood: current trends and evolving management concepts.

Sarcomas are rare, malignant bone and soft-tissue tumours of mesenchymal origin, and their overall incidence accounts for 1% and 0.2%, respectively, of all malignancies. The aim of this article is to provide a reference on the evolving management concepts and trends of treatment of adult sarcomas of the head and neck in a major head and neck sarcoma centre. Early diagnosis remains a challenge due to non-specific symptomatology. Imaging such as ultrasound (US), magnetic resonance (MRI), computed tomography (CT), and positron emission tomography (PET) CT assist with diagnosis and staging, and biopsy is essential for diagnosis, tumour differentiation, and grading. Staging is dependent on histological grade, size of tumour, and metastasis. Sarcomas spread via the haematogenous route. Adequate clearance of locoregional disease and prevention of distant micrometastases are key to improved disease-free survival outcomes so multimodal treatment at a sarcoma reference centre is imperative. In the head and neck, the treatment for most bone sarcomas is neoadjuvant chemotherapy followed by compartmental resection. The interim tumour response to neoadjuvant chemotherapy is evaluated by PET CT and MRI. Heavy-particle therapy (proton beam) in combination with surgery is increasingly being used to treat otherwise unresectable disease, particularly in children. For soft tissue sarcomas of the head and neck, treatment is complex and depends on grade. Surgery is the principle mode of treatment in low-grade tumours that are amenable to resection. High-grade tumours can be treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. In such cases, the response to the chemotherapy might be used as a guide of potential biological aggressiveness, and has an impact on the planning of the operation and the type and extent of radiotherapy. As a general rule, radiotherapy is reserved for high-grade, advanced soft-tissue sarcomas of the head and neck. Those of bone are radioresistant, and radiotherapy is only administered for palliative purposes when no surgical option exists, an exception being Ewing sarcoma. The role of proton beam therapy is promising, but to our knowledge no long-term data currently exist. The survival advantage of innate immune-modulation remains uncertain for disease in the head and neck.

Head and neck sarcomas: the first report addressing the duration of symptoms and diagnostic work up

Background: Head and neck sarcomas are rare and difficult to diagnose and manage.Aim: To describe a population of patients with head and neck sarcomas focusing on the effect of symptom duration and time to diagnosis on mortality and recurrence risk.Materials and methods: Fifty-one patients treated in our department between 1998–2013 were retrospectively included. Patient and tumour characteristics as well as dates of interest were obtained from sarcoma registries, charts and pathology records. The effect of symptom duration and time to diagnosis on mortality and risk of recurrence was tested by multivariate analysis.Results: There was a wide range in symptom duration (1–144 months, median 5) and time for diagnosis (0–234 days, median 14) without significant effect on overall mortality, disease-specific mortality or risk of recurrence. Chondrosarcomas in the larynx dominated among the patients with the longest diagnostic duration.Conclusion and significance: The diagnostic process is challenging and in some cases of extremely long duration without effect on mortality. The symptom duration and time to diagnosis in relation to mortality and risk of recurrence has not previously been described. Early biopsy, better imaging and advanced pathological techniques can hopefully speed up the diagnostic process and reduce morbidity and mortality.

The Management of Head and Neck Sarcoma.

To describe the incidence, types, features, treatment and outcomes of head and neck sarcoma managed at a treatment center in eastern China. Cases of head and neck soft tissue sarcoma and osteogenic sarcoma treated at the Stomatology Hospital of Nanjing University between 2008 and 2018 were retrospectively analyzed. Patient characteristics, site of lesion, main presenting symptoms, treatment, histology, local recurrence, development of metastatic disease, duration of follow-up and survival rates are described and compared. Sixty-three patients were diagnosed with head or neck sarcoma of which 42.9% had soft tissue sarcoma and 57.1% had osteogenic sarcoma. Of soft tissue sarcoma patients, the most frequently observed histologies were fibrosarcoma and malignant fibrous histiocytoma. Of 36 cases of osteogenic sarcoma, osteosarcoma, and fibrosarcoma of bone were most frequent. Mean latency period between initial symptoms and clinical presentation was 4.5 months. Radical resection was performed on 56 patients. For 33 patients, resection and radiotherapy were used and 10 patients received a triple combination of resection, chemotherapy and radiotherapy. Within the observation period, 17 patients died. Head and neck sarcomas, although rare, can represent a variety of pathological diagnoses. Surgery remains the main intervention although the data suggest chemotherapy, radical resection and irradiation as treatment. Outcomes are poor with high rates of local recurrence. Positive prognostic factors were tumor-free resection margins and choice of therapy. Due to the rarity of head and neck sarcoma, information remains limited and choice of treatment should be within the focus of clinical multi-center studies.

The occurrence and pattern of head and neck sarcomas: a comprehensive cancer center experience.

This study aimed to analyze the demographics, clinicopathological, treatment, and survival characteristics of head and neck sarcomas diagnosed in a reference center in the Brazilian Northeast. This retrospective cohort study reviewed the clinical records of patients with head and neck sarcomas. Epidemiologic data consisted in clinical location, age, gender, histopathological diagnosis, clinical TNM staging and treatment. Outcome variables were local recurrence and survival. The statistical analyses were performed by a binary logistic regression analysis. The survival analysis was assessed through the Kaplan-Meier curve. Sixty-nine patients with head and neck sarcomas (male 39; female 30) were analyzed. The most common histologic subtypes were rhabdomyosarcoma, dermatofibrosarcoma, and pleomorphic sarcoma. The mean age of the patients at the time of diagnosis was 38.1years old. A total of 31 patient died (sarcoma-related death) up to the end of the follow-up, with a mean follow-up rate of 1.63years. A multivariate analysis revealed that anatomical site, treatment modality, histopathological diagnosis, and clinical stage of the disease were associated with specific survival, reaching statistical significance. This study demonstrates the impact of important clinical-pathological parameters on the overall prognosis of head and neck sarcomas.

An Unusual Presentation of Leiomyosarcoma Posing a Diagnostic Dilemma: A Case Report

Leiomyosarcoma (LMS) is a malignant tumour of smooth muscle origin commonly seen in genital and gastrointestinal location. However, its presence in the head and neck region in a young child is extremely rare. Authors present a unique case of LMS in a one year and five-month-old child who presented with a painless mass in the right temporal region of the head. Histopathological examination revealed a highly cellular tumour arranged in intersecting fascicles of spindle cells with brisk mitotic activity and interspersed areas of necrosis. On Immunohistochemistry (IHC), the tumour cells were positive for Smooth Muscle Actin (SMA), Desmin and Vimentin and negative for S100 and Myogenin. A diagnosis of LMS was thus, made. Head and neck sarcoma is a broad entity encompassing plethora of differentials with closely overlapping morphological features which renders them diagnostically challenging, this can be resolved by employing various immunohistochemical stains readily available in all laboratories. This case highlights the combined role played by histopathology and immunohistochemistry in arriving at the correct diagnosis. To the best of our knowledge, this is the first case of LMS reported in the temporal region of head and is distinct with respect to its rare incidence, location and age at presentation. LMS at this site may masquerade as deceptively benign painless mass and may not be suspected initially, however one should bear in mind that these are moderate-to-high grade tumours and any delay in management may portend poor prognosis. Timely and aggressive surgical management is thus, the mainstay of treatment and critical to patient survival.

A study on correlates of acute cutaneous manifestations in head and neck cancer patients treated with radiation therapy

Skin injuries occur in about 95% of patients who receive RT. Anybody site treated with RT is susceptible to cutaneous injury; however, the face, neck, trunk, and extremities are particularly vulnerable. Patients with breast cancer, head and neck cancer, lung cancer, and sarcoma are most often affected because of the higher radiation doses to the skin. RT was formerly used by dermatologists in the treatment of benign conditions such as acne, eczema and psoriasis. Patients receiving radiation therapy for Head and Neck malignancies attending the outpatient clinic in Department of Dermatology, Venereology and Leprosy and Radiotherapy and also inpatients in Radiotherapy wards were included in this study. The most common co-morbidity observed in this study was anemia in 39 patients (78%), followed by diabetes mellitus in 6 patients (12%) followed by hypertension in 3 patients (6%), both hypertension and diabetes mellitus was seen in 1 patient (2%) and hypertension, diabetes mellitus and IHD was seen in 1 patient (2%).

A systematic analysis of immune genes and overall survival in cancer patients

BackgroundOverall survival (OS) is a key endpoint measure in the management of patients with cancer. Immunotherapy has become a dominant strategy in cancer therapy. To investigate the relationship between OS and the immune system, we assessed the role of immune genes in OS in 8648 patients across 22 cancer types.MethodsGene expression data and clinical information were collected from The Cancer Genome Atlas (TCGA) and cBioPortal. Survival analysis was performed with a Cox proportional hazards regression model.Results(1) The number of prognostic genes, prognostic immune genes (PIGs) and the hazard ratio (HR) of PIGs in different cancer types all varied greatly; (2) KEGG pathway enrichment analyses indicated that the prognostic genes of 6 cancer types were significantly enriched in multiple (≥5) immune system-related pathways. Of the PIGs in these 6 cancer types, we screened 48 common PIGs in at least 5 cancer types. Eleven out of the 48 PIGs were found to participate in the T cell receptor (TCR) signaling pathway according to the STRING database. Among these genes, ZAP70, CD3E, CD3G, CD3D, and CD247 were part of the TCR ‘signal-triggering module’; (3) High expression of the PIGs involved in the TCR signaling pathway was associated with improved OS in 5 cancer types (breast invasive carcinoma (BRCA), cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC), head and neck squamous cell carcinoma (HNSC), lung adenocarcinoma (LUAD), and sarcoma (SARC)), but was associated with decreased OS in brain lower-grade glioma (LGG).ConclusionsThe TCR signaling pathway played a distinct role in the OS of these 6 cancer types.

416P - Multidisciplinary management of sarcomas of the head and neck: An institutional experience

BackgroundHead and neck cancer is one of the most common malignancies in India, with the highest incidence worldwide. Our aim was to study head and neck sarcomas- tumor types, their treatment strategies, recurrence patterns and survival in patients treated in a tertiary centre in the densely populated Northern India. MethodsThis is a retrospective study of a prospectively maintained database. Patients treated between January 2011- June 2016 at the centre were included. Surgical treatment was wide excision (aim was to get disease free margins within the restrictions of the region). Chemotherapy was mainly doxorubicin-based with drugs like cisplatin, ifosfamide, etoposide, vincristine and cyclophosfamide added as per the histology. Radiotherapy was given as part of the curative treatment in Ewing’s sarcoma. Adjuvant radiation therapy was given in close/involved margins or locally advanced disease in other histologies. Patients with distant or locally advanced disease underwent multimodal management. ResultsThe study included 29 cases. Histologies were varied, with the most common type being osteosarcoma, followed by chondrosarcoma. Ewing’s sarcoma, pleomorphic sarcoma and spindle cell sarcoma were the other common types. Most common site of involvement was mandible. Surgery was done in 68.9% (n = 20). High grade disease was seen in 22 patients (75.9%). Margins were clear in 17 patients (80.9%); close margins were documented in 4 patients (19%). Locoregional and distant recurrences occurred in 15% (n = 3) & 10% (n = 2), respectively. Factors affecting the risk of recurrence are high grade, close margins and locally advanced disease. However there is no influence of size, grade or margin status on survival. Median survival was 33 months. The 3 year disease free survival was 52% (95% CI- 0.44-0.83). ConclusionsHead and neck sarcoma is a rare heterogeneous group in one of the commonest sites of malignancy in India. Apart from appropriate identification of the cases, the better chance of survival is provided by an expert unit with multidisciplinary management, and chance of surgical salvage in case of recurrence. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Imaging Soft-tissue Sarcomas of the Head and Neck: A Tertiary Soft-tissue Sarcoma Unit Experience.

To describe imaging features of head and neck soft-tissue sarcomas. Patients with a diagnosis of head and neck sarcoma between 2011 and 2015 were reviewed. There were a total of 62 patients (24 female; median age=60 years). Most common sarcomas were angiosarcoma, undifferentiated pleomorphic sarcoma and sarcoma not otherwise specified. They were most commonly located in cranial and neck superficial soft tissues. Average tumour size at presentation was 45 mm. One patient had metastasis at presentation (rhabdomyosarcoma); two had nodal disease (rhabdomyosarcoma and angiosarcoma) and two tumours contained calcification (chondrosarcoma and synovial sarcoma). Four arose after prior radiotherapy. Unlike the more common diagnosis of squamous cell carcinoma, the majority of head and neck sarcomas present as large, solitary, superficial masses without lymph node enlargement. Identification of these features on imaging should raise suspicion of a sarcoma diagnosis, particularly in the setting of previous irradiation or genetic susceptibility.

Efficacy and Safety of CT-Guided 125I Seed Implantation As a Salvage Treatment for Locally Recurrent Head and Neck Soft Tissue Sarcoma after Surgery and External Beam Radiotherapy: A 12-Year Study at a Single Institution

The treatment for locally recurrent head and neck soft tissue sarcoma (HNSTS) after failure of previous surgery and external beam radiotherapy (EBRT) remains a problematic challenge without widely accepted recommendations. We aimed to evaluate the efficacy and safety of CT-guided radioactive 125I seed (RIS) implantation for the treatment of locally recurrent HNSTS after surgery and EBRT and analyze the prognostic factors of efficacy. Between December 2006 and February 2018, 25 patients with locally recurrent HNSTS after failure of surgery and EBRT were erolled. We re-staged the recurrent tumors according to the American Joint Committee On Cancer (AJCC) System for soft tissue sarcoma of the head and neck sarcoma (8th ed, 2017) when analyzing the data. All these patients successfully underwent treatment with computed tomography (CT)-guided 125I seed implantation. The postoperative evaluation of seed and dose distribution was performed immediately after surgery. The primary endpoints included the objective overall response rate (ORR) and local progression-free survival (LPFS), and the secondary endpoints were overall survival (OS) and safety profiles. Following 125I seed implantation brachytherapy, the ORR was 72.0%, median LPFS was 16.0 months and median OS was 28.0 months. Furthermore, the 1-, 2-, 3-, 4- and 5-year LPFS rates were 65.6%, 48.1%, 34.4%, 22.9%, and 22.9% respectively and the 1-, 2-, 3-, 4- and 5-year survival rates were 70.8%, 56.9%, 46.6%, 40.8%, and 34.0%, respectively. Multivariate analyses showed that the recurrent T stage (T4 vs ≤ T3；hazard ratio [HR]= 4.020; 95% confidence interval [CI]= 1.117-14.466; P=0.033) and histological grade (G3 vs ≤ G2；HR= 3.260; 95% CI= 1.031-10.306; P=0.044) were independent prognostic factors of LPFS, whereas only the histological grade (G3 vs ≤ G2；HR= 3.230; 95% CI=1.061-9.834; P=0.039) was an independent predictor of OS. The major adverse events were skin/mucosal toxicities, which were generally of lower grade (≤ grade 2) and well tolerated. RIS implantation could be an effective and safe alternative treatment for locally recurrent HNSTS after failure of surgery and EBRT. Recurrent T stage and histological grade were the main factors influencing the efficacy.

Abstract 5134: Landscape of genomic alterations across solid tumors based on a comprehensive clinical sequencing analysis of 5355 Chinese cancer patients

Abstract Background: Precision oncology highlights the individualization of diagnosis, prognosis and treatment based on molecular stratification of cancer patients (pts). Genetic patterns in many types of cancer vary among geographical regions, leading to variation in evidence-based recommendations for clinical management of pts. Genomic alterations (GAs) of solid tumors from Chinese pts have not been fully studied across all cancer types. Methods: Tumor tissues and matched blood from 5355 Chinese pts were collected and sequenced by a next generation sequencing based 450-gene panel assay. About 60% of the samples were FFPE tissues. In our study, 59% were males and 41% were females with a median age of 58 years old (range 1-92). The major cancer types were NSCLC (36%), CRC (8%), HCC (7%), gastric cancer (5%), pancreatic cancer (5%), and also cholangiocarcinoma, esophageal carcinoma, SCLC, gallbladder carcinoma, ovarian cancer, breast cancer, head and neck cancer, sarcoma, renal carcinoma, uterine neoplasms and others. 1% were pediatric patients . Single base substitutions, short and long insertions/deletions (indels), copy number alterations (CNA), fusions/rearrangements, TMB and MSI status were assessed by NGS. Results: On average, our study identified 7 mutations per patient. Gene rearrangements and long indels (50bp - 2k) were detected in 15% and 5% of the cancers. In total, 58% of pts harbored GAs in druggable genes defined as targets of FDA approved drugs. Highest mutation frequencies were found in TP53 (60%), EGFR (23%), KRAS (18%), CDKN2A (13%), TERT (12%), PIK3CA (11%), APC (11%), LRP1B (10%), ARID1A (9%), and RB1 (8%) across all tumor types. The frequency of other druggable genes included BRCA1/2 (5%), BRAF (3%), HER2 amplifications (3%), MET amplifications (2%), ALK fusions (2%), RET fusions (0.7%), ROS1 fusions (0.7%), FGFR fusions (0.7%), NTRK fusion (0.6%). Frequency of GAs in druggable genes varied among different tumor types. For instance, EGFR mutations occurred in 49% of NSCLC, 7% of SCLC, 2% of gastric cancer, and 2% of CRC. NTRK fusions enriched in sarcoma (4%), gastric cancer (2%) and CRC (1%). The median TMB of the whole cohort was 4.6 muts/Mb and 6% had TMB higher than 20 muts/Mb. Top 3 tumors with highest median TMB were SCLC, CRC and gastric cancer, while pancreatic cancer and sarcoma had low TMB. As a pan-cancer biomarker for immunotherapy, pts with MSI-H accounted for 1.3% of solid tumors, including 9% of uterine neoplasms, 8% of CRC, 6% of gastric cancer and 2% of ICC. Conclusions: In summary, we have constructed a large-scale data set including somatic mutations, CNAs, fusions/rearrangements, TMB and MSI status from 5355 Chinese pts with more than 19 tumor types, which provided an extensive understanding of disease-specific indicators, outcomes and therapeutic strategies for both targeted and immune therapies in Chinese pts. Citation Format: Ming Yao, Minghui Wang, Mingwu Chen, Tao Shou, Jingyu Cao, Hui Chen, Aodi Wang, Lijuan Chen, Jinwei Hu, Shuirong Zhang, Kai Wang. Landscape of genomic alterations across solid tumors based on a comprehensive clinical sequencing analysis of 5355 Chinese cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5134.

Intensity-Modulated Proton and Carbon-Ion Radiation Therapy in the Management of Head and Neck Sarcomas.

PurposeWe report our experience of intensity‐modulated proton and carbon‐ion radiotherapy (IMPT/IMCT) for head and neck sarcomas (HNS).Methods and MaterialsAn analysis of the ongoing prospective data registry from the Shanghai Proton and Heavy Ion Center (SPHIC) for patients with HNS was conducted. The 12‐ and 24‐month rates of local recurrence‐free, overall, distant metastasis‐free, progression‐free survival (LRFS, OS, DMFS, and PFS), and acute/late toxicities were calculated. The prognostic factors for the effectiveness of the treatment were also analyzed.ResultsBetween 7/2014 and 5/2018, 51 consecutive patients with HNS received definitive doses of IMCT (41 cases), IMPT (two cases), or their combination (eight cases). One patient had R0 resection and another treated on the Chinese Food and Drug Administration registration trial received IMPT only. Twenty‐seven patients were treated according to various dose escalation trials or institutional protocols using IMCT or IMPT + IMCT boost. Twenty‐two patients with locoregional recurrence (10 and four patients failed surgery or surgery followed by radiotherapy, respectively) or radiation‐induced second primary sarcomas (eight patients) received salvage particle radiotherapy. With a median follow‐up time of 15.7 months, four patients with second primary sarcoma died. The 1‐ and 2‐year OS, PFS, LRFS, and DMFS rates for the entire cohort were 92.9% vs 90%, 73.6% vs 57.4%, 88.4% vs 78.9%, and 84.6% vs 76.5%, respectively. Those rates for patients without prior radiotherapy were 100% vs 100%, 82.1% vs 65.8%, 93.6% vs 85.3%, and 88.4% vs 79.5%, respectively. Multivariate analyses revealed that re‐irradiation was an independent prognostic factor for both LRFS and PFS (P = 0.015 and 0.037, respectively). In addition, gross tumor volume (GTV) was an independent prognostic factor for PFS (P = 0.048). One patient experienced Grade 3 acute toxicity (oral mucositis); another experienced Grade 4 acute event (hemorrhage) which required embolization. He lately died from hemorrhage (Grade 5) at 3.4 months after the completion of treatment. No patient experienced radiation‐induced acute/late toxicity of ≥ Grade 2 otherwise.ConclusionWith few observed acute/late toxicities, IMPT/IMCT provided effective short‐term tumor control in our patients with HNS. Further investigations, preferably in a prospective fashion, will be required to confirm the efficacy and toxicities of IMPT/IMCT in this group of patients.

SARCOMAS OF THE HEAD AND NECK- A 10-YEAR REVIEW FROM A SPECIALIST CENTRE

Objectives Head and neck (H&N) sarcomas are rare mesenchymal lesions accounting for 5-15% of all sarcomas with a poor prognosis. Their management can be challenging due to the complex anatomy, difficulty in surgical removal and heterogeneity within and between lesions. The aim of this study was to determine the range and demographics of all histologically confirmed H&N sarcomas over a 10-year period seen at a regional specialist sarcoma centre. Information about grade, margin clearance, treatment modality, metastasis and recurrence was analysed and correlated to survival. Findings 87 sarcomas were identified using the local database with a male prevalence (67%) and a mean age of 43 years. The most common diagnoses were angiosarcoma, pleomorphic sarcoma NOS (14.9%), chondrosarcoma (10.34%) and rhabdomyosarcoma (9.2%). The most commonly involved sites were scalp (26.44%), neck (12.64%), buccal mucosa and temporal fossa (9.2%). The majority of the lesions were Trojani grade 3 (44%). A large proportion of the sarcomas were smaller than 5 cm (70%). 97% of cases were treated with curative intent with surgery the first intervention in 77% cases and chemoradiotherapy in the remaining 23%. When surgery was employed, excision was undertaken for 90% of cases and debulking for the remaining 10%. 47% cases developed a recurrence which was predominantly locoregional (68%) and related to margin involvement (p Conclusions Head and neck sarcomas are rare and complex lesions requiring multidisciplinary management. Our survival rates are similar to those reported in literature with grade and metastasis being the most important predictors of survival. National and international databases are required for multicentre registration and better identification of prognostic factors.

Persistent radiation-induced alopecia in patients with central nervous system tumors and head and neck sarcomas.

e23072 Background: Persistent radiation-induced alopecia (pRIA), or incomplete hair regrowth 6 months following radiotherapy (RT) completion, poses a significant quality of life burden, but its clinical characteristics and management outcomes are not well understood. Methods: Retrospective database query of patients with primary central nervous system tumors or head and neck sarcomas evaluated at an oncodermatology clinic and diagnosed with pRIA between 1/1/11 and 9/19/18. Clinical data and standardized clinical photographs were analyzed. Alopecia was graded according to the CTCAE v5. Results: Sixty-two patients with pRIA were identified (mean [SD] age, 33 [19]; 75% female; 18 &lt; 21 years at pRIA diagnosis). The most common diagnoses were medulloblastoma (20, 32%) and glioblastoma multiforme (17, 27%). Mean duration between RT and pRIA diagnosis was 3.1 years (95% CI, 2.3-4.2). Additional cancer therapies included surgery (57, 92%), cytotoxic chemotherapy (35, 57%), and combination cytotoxic + targeted therapy (24, 39%). Cancer type, age, number of chemotherapy agents, and duration between RT and pRIA diagnosis were significantly associated with alopecia type: mixed pattern (localized and diffuse) alopecia was predominant in younger patients with medulloblastoma exposed to greater number of agents (p &lt; .005). Alopecia grade 2 ( &gt; 50% hair loss) was predominant in patients that received concurrent chemotherapy and RT (p = .046). Among 22 patients treated with 5% minoxidil topical solution, a response was noted in 16 (73%) (Table). One patient receiving hair transplantation and one receiving scalp reconstruction had complete resolution of pRIA. Conclusions: Concurrent chemotherapy with RT may be a risk factor for grade 2 pRIA. Topical minoxidil may provide some benefit in pRIA; however, prospective trials are needed to assess efficacy. Procedural interventions should be considered as a viable therapeutic option in a subset of patients. [Table: see text]

Recommendations in management of head and neck sarcomas

Sarcomas of the head and neck are rare malignant tumours with incidence 2% of head and neck cancers, 30% of all sarcomas in children and 4–10% of sarcomas in adults. The most common sarcoma in children is rhabdomyosarcoma (RMS) and Ewing sarcoma (ES), in contrary in elderlies there is angiosarcoma; osteosarcoma and chondrosarcoma are the most common bone tumours in head and neck. The typical symptoms are: painless tumour in the head and neck region, difficulty with speaking, hoarseness, dysphagia, nasal obturation, or dysfunction of cranial nerves. The key point of diagnostics is magnetic resonance and computed tomography of the primary tumour. The treatment of patients with sarcoma should be carried out in referral centers, where experienced multidisciplinary team proceed the surgical removal of a primary tumour with reconstructive surgery as well as perioperative systemic therapy (in selected cases). The recommendations were developed by the Head and Neck Sarcoma Group of the Polish Registry of Bone Tumors.