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Sarcomatoid Carcinoma in Head and Neck: A Review of 30 Years of ExperienceClinical Outcomes and Reconstructive Results

Chang, Nai-Jen MD*†; Kao, Dennis S. MD*†; Lee, Li-Yu MD†‡; Chang, John Wen-Cheng MD†§; Hou, Ming-Mo MD†§; Lam, Wee Leon MB, ChB, M Phil, FRCS (Plast)*†; Cheng, Ming-Huei MD, MBA, FACS*†

doi: 10.1097/SAP.0000000000000069
Clinical Papers

Problem Presented: Sarcomatoid carcinoma (SaCa) is a rare variant of squamous cell carcinoma (SCC) with sarcomatoid features. This study investigated the clinical presentation and outcomes of head and neck SaCa. In addition, reconstructive outcome for a subset of patients was also evaluated.

Studies Undertaken: Seventy-eight SaCa cases including 72 men and 6 women were identified from 13,777 head and neck SCC cases. Clinical outcomes were evaluated based on locoregional control, distant metastases, and multivariate analyses. Reconstructive outcome was evaluated by flap survival rate.

Result: Of the 78 cases, 71% (55) of cases were located in the oral mucosa; 64% (50) of patients were classified as T3 or T4 at the time of diagnosis. The 5-year survival was only 16%. Multivariate analysis revealed better outcomes only when the patient had a history of previous SCC. Forty-five patients underwent flap reconstruction, with 98% flap survival rate but the functional result varied because of the inevitable adjuvant radiotherapy and advanced stage of tumor.

Conclusions: Sarcomatoid carcinoma is a different entity from the conventional SCC of the head and neck. Sarcomatoid carcinoma carries a poorer prognosis despite aggressive surgical intervention and concurrent adjuvant therapies. It remains a great challenge for clinical oncologists, and the optimal treatment strategy requires further studies. Free flap is still preferred for defect reconstruction but the design should be simplified to avoid complications.

From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou; †Chang Gung University College of Medicine, Taoyuan; ‡Department of Pathology, and §Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

Received October 9, 2013, and accepted for publication, after revision, October 25, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Ming-Huei Cheng, MD, MBA, FACS, Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Chang Gung Medical College, Chang Gung University, 5, Fu-Hsing St, Kweishan, Taoyuan 333, Taiwan. E-mail: minghueicheng@gmail.com; minghuei@adm.cgmh.org.tw.

© 2013 by Lippincott Williams & Wilkins