An analysis of the effectiveness of differential diagnosis and surgical treatment of neck soft-tissue sarcomas in children
- Authors: Polev G.A.1,2, Grachev N.S.1, Vorozhtsov I.N.1, Babaskina N.V.1, Kachanov D.Y.1, Stradomskaya T.V.1, Teleshova M.V.1, Iaremenko E.Y.1
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Affiliations:
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
- Ilyinsky Hospital
- Issue: Vol 22, No 4 (2023)
- Pages: 37-51
- Section: ORIGINAL ARTICLES
- Submitted: 08.09.2023
- Accepted: 17.10.2023
- Published: 20.12.2023
- URL: https://hemoncim.com/jour/article/view/757
- DOI: https://doi.org/10.24287/1726-1708-2023-22-4-37-51
- ID: 757
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Abstract
We conducted a retrospective sample study with prospective collection of follow-up data. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. In the time period from January 2013 to August 2020 (92 months), 126 patients with head and neck soft-tissue sarcomas (STS) received treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. We included 25 patients who had undergone surgery for neck STS and divided them into 4 groups (rhabdomyosarcoma (RMS), non-RMS-like STS, RMS-like STS, IRS-IV STS – with distant metastasis at baseline). The median age at the time of correct diagnosis was 2.6 (0.5; 5.0). The median time from symptom onset to the verification of the correct pathomorphological diagnosis was 3.2 (1.6; 4.9) months. We discovered a significant number (13/25, 52%) of cases of biopsy that was performed improperly (excessive/non-diagnostic biopsy, fine-needle aspiration biopsy) at a general inpatient facility. The correct pathomorphological diagnosis was clinically and statistically much more often made at a reference center (20/25, 80%; p = 0.003). Moreover, more than half of pathomorphological diagnoses (8/13, 62%) made at a general inpatient facility were later changed at a reference center. Radical resection was achieved in 17/20 (85%) survivors. In 3/20 (15%) cases, a repeat surgery was not needed because of the patients' complete response to protocol-based treatment. Radiotherapy was carried out in 11/25 (44%) cases. Protocol-based treatment was completed in 19/25 (76%) patients, 18/25 (72%) patients achieved complete response, 2/25 (8%) patients were considered incurable, and 4/25 (16%) children died before the completion of therapy. Post-operative complications of varying severity were observed in 10/25 (40%) cases and were dependent on the degree of STS extension and the severity of the condition of the patients undergoing intensive protocol-based treatment. The median time of patient observation since diagnosis verification was 33.2 (15.6; 74.2) months. The five-year overall survival (OS) was 76.3% (95% confidence interval (CI) 51.8; 89.5), the five-year event-free survival without local disease progression – 73.9% (95% CI 41.8–90.1). Even though there weren't many patients with IRS-IV in our study (4/25, 16%), their exclusion from the analysis resulted in a higher 5-year OS rate: 88.2% (95% CI 60.2; 96.9). This study revealed significant problems in the differential diagnosis of neck STSs in children. In most patients receiving optimal protocol-based treatment, neck tumors can be radically removed at a specialized healthcare facility without mutilating surgery, which results in high 5-year OS and event-free survival rates in patients without distant metastasis. Our findings require further investigation in a larger sample of patients.
About the authors
G. A. Polev
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation;Ilyinsky Hospital
Author for correspondence.
Email: neck.masses@yandex.ru
ORCID iD: 0000-0002-7175-6417
SPIN-code: 7778-3356
Georgy A. Polev, Cand. Med. Sci., a senior researcher at the Department of Head and Neck Surgery and Reconstructive Plastic Surgery;
Director of Head and Neck Surgery Center at the Ilyinsky Hospital
1 Samory Mashela St., Moscow 117997
Russian FederationN. S. Grachev
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: nick-grachev@yandex.ru
ORCID iD: 0000-0002-4451-3233
Moscow
Russian FederationI. N. Vorozhtsov
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: dr.vorozhtsov@gmail.com
ORCID iD: 0000-0002-3932-6257
SPIN-code: 6155-9348
Moscow
Russian FederationN. V. Babaskina
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: nbabaskina@bk.ru
ORCID iD: 0000-0003-4264-1423
SPIN-code: 5464-5364
Moscow
Russian FederationD. Yu. Kachanov
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: denis.kachanov@fccho-moscow.ru
ORCID iD: 0000-0002-3704-8783
SPIN-code: 9878-5540
Moscow
Russian FederationT. V. Stradomskaya
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: stv-sergeeva@mail.ru
ORCID iD: 0000-0003-0621-191X
SPIN-code: 9291-1140
Moscow
Russian FederationM. V. Teleshova
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: clinoncology@gmail.com
ORCID iD: 0000-0003-4042-0125
Moscow
Russian FederationE. Yu. Iaremenko
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation
Email: selvaggio@yandex.ru
ORCID iD: 0000-0003-1196-5070
SPIN-code: 3203-9151
Moscow
Russian FederationReferences
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