Chondrosarcomas of the Head and Neck: A 50-Year Review

Summary: Chondrosarcomas of the head and neck are rare heterogenous malignant tumors of cartilaginous lineage. The objectives of our study were to report our experience in the surgical management and to identify factors predictive of outcome.

Methods: Sixty-six patients with head and neck chondrosarcomas treated at Memorial Sloan Kettering Cancer Center were divided in two cohorts from 1955 to 1985 and 1985 to 2005. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined for each cohort by the Kaplan-Meier method.

Findings: Five-year OS was superior in the 1985–2005 cohort compared with the 1955–1985 cohort (86.5% vs. 54%). In the 1985–2005 group, 5-year DSS and RFS were 89.5% and 51%, respectively. For RFS, grade, margin status, and postoperative radiation (PORT) were predictors of outcome. High- and intermediate-grade tumors had poorer RFS compared to low grade tumors (22.6% vs 70%, P = 0.02). RFS was worse with positive margins compared with negative margins (30.5% vs. 81.5%, P = 0.004). Patients with positive margins, patients treated with PORT had better RFS (45.7% vs. 18.2%). Sinus and skull base tumors had poorer RFS (43.4% vs. 70%, P = 0.35).

For DSS, margin status, anatomical site, and grade were not predictive. Despite poorer RFS, patients with high-grade tumors and/or positive margins were salvaged by surgery and/or radiation therapy (RT) such that DSS was similar to that of patients with low-grade tumors and negative margins (DSS for high-grade vs. low-grade was 84% and 93%, respectively, P = 0.1; DSS for positive vs. negative margins was 90% vs. 89%).

Interpretation: Survival of head and neck chondrosarcomas has improved over the past 25 years largely due to the use of adjuvant PORT. Despite high rates of recurrence in high-grade tumors, positive margins, and skull base locations, DSS is improved by successful salvage with further surgery and radiation therapy.