Head and neck sarcomas across two decades: a retrospective study of clinicopathologic patterns and oncologic outcomes

Head and neck sarcomas (HNS) are rare and heterogeneous malignancies with unique anatomical and biological challenges. This study aimed to evaluate clinicopathologic features, treatment approaches, and survival outcomes of bone versus soft tissue HNS, with stratification by grade and anatomical site.

A retrospective review was conducted of 77 consecutive patients with HNS treated at a tertiary referral center between 2000 and 2021. Tumors were classified as bone or soft tissue sarcomas. Clinical characteristics, treatment modalities, and outcomes were analyzed. Survival was estimated using the Kaplan-Meier method and prognostic factors were assessed with Cox proportional hazards models.

Nineteen patients (24.7%) had bone sarcomas, which were uniformly high-grade, diagnosed at a younger age, and commonly managed with multimodal therapy. Their 5-year overall survival was 76.0%. Fifty-eight patients (75.3%) had soft tissue sarcomas, with more heterogeneous histology and grade; the 5-year overall survival was 60.4%, and recurrence occurred in 46.6%. Tumors located in the skull base and paranasal sinuses more often had positive margins but did not demonstrate inferior survival compared to other sites. Patients treated with the "sandwich modality" (neoadjuvant therapy, surgery, and adjuvant therapy) showed lower recurrence rates compared with other treatment strategies.

Tumor grade was the most significant prognostic factor in HNS, while histologic type and site also influenced management strategies. The sandwich modality was associated with lower recurrence and warrants further investigation. Individualized, guideline-driven multimodal care remains central to optimizing outcomes in this rare disease.