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Primary osteosarcoma of the head and neck in pediatric patients
Author(s) -
Gadwal Shyam R.,
Gan Francis H.,
FanburgSmith Julie C.,
Becoskie Elizabeth M.,
Thompson Lester D. R.
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010201)91:3<598::aid-cncr1040>3.0.co;2-d
Subject(s) - medicine , osteosarcoma , headaches , radiation therapy , head and neck , maxilla , chemotherapy , sarcoma , surgery , radiology , pathology , dentistry
BACKGROUND Primary osteosarcomas of the head and neck in the pediatric age group, not associated with previous irradiation or a known syndrome, are rare. The literature contains several single cases and small study series; however, to the authors's knowledge, there has been no comprehensive large study to evaluate the clinicopathologic aspects of these tumors. METHODS Twenty‐two cases of osteosarcomas of the head and neck in patients 18 years of age or younger, diagnosed between 1970 and 1997, were retrieved from the Otorhinolaryngic−Head & Neck Tumor Registry of the Armed Forces Institute of Pathology (AFIP). No secondary sarcomas (radiation‐induced or those arising after chemotherapy) or those associated with known syndromes were included. Clinical, radiographic, and histologic features were reviewed, and patient follow‐up was obtained. RESULTS The patients included 11 girls and 11 boys, 1–18 years of age (mean, 12.2 yrs). Patient symptoms related to tumor location were painless swelling, loss of teeth, headaches, or a mass lesion, present for an average of 5.9 months. No genetic abnormalities were documented. The tumors most frequently involved the mandible ( n = 19), followed by the sphenoid sinus ( n = 2) and the maxilla ( n = 1). The tumors ranged in size from 1.1–10.0 cm (mean, 4.5 cm). All tumors were invasive and malignant by radiology and/or histology. The tumors were Grade 1 ( n = 11), Grade 2 ( n = 8), or Grade 3 ( n = 3). All cases, except one chondroblastic osteosarcoma, were osteoblastic osteosarcomas. Thirteen patients underwent initial surgical resection with ( n = 5) or without ( n = 9) additional radiation and/or chemotherapy. The remaining 9 patients had an initial biopsy for diagnosis followed by surgery ( n = 4) or surgery and radiation and/or chemotherapy ( n = 5). Follow‐up was available for 19 patients: 13 were alive at last follow‐up with no evidence of disease (mean, 13.1 yrs); 1 was alive with disease (1.3 yrs); 3 had died without evidence of disease (mean, 23.2 yrs); and 2 had died of disease (mean, 7.8 yrs). The 3 patients with high‐grade osteosarcoma were alive without disease (mean, 20.0 yrs). CONCLUSIONS Primary head and neck osteosarcomas in the pediatric population are typically low‐ to moderate‐grade lesions in the mandible. Despite the invasive nature and high grade of a few of these tumors, there is an excellent overall long‐term prognosis for patients in this age group with tumors in these locations. Cancer 2001;91:598–605. © 2001 American Cancer Society.