J Neurol Surg B Skull Base 2018; 79(05): 437-444
DOI: 10.1055/s-0037-1615816
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Kenya Kobayashi
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Fumihiko Matsumoto
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Yasuji Miyakita
2   Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Taisuke Mori
3   Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
,
Tatsunori Shimoi
4   Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Naoya Murakami
5   Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Akihiko Yoshida
3   Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
,
Ayumu Arakawa
6   Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Go Omura
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Masahiko Fukasawa
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Yoshifumi Matsumoto
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Satoko Matsumura
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Jun Itami
5   Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Yoshitaka Narita
2   Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
,
Seiichi Yoshimoto
1   Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

28 July 2017

19 November 2017

Publication Date:
09 January 2018 (online)

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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.