Malignant peripheral nerve sheath tumors of the head and neck: Demographics, clinicopathologic features, management, and treatment outcomes

• The SEER database was queried for patients with MPNST of the head and neck.
• Clinicopathologic and therapeutic determinants of patient survival were analyzed.
• Surgical resection confers survival benefit in patients stage I/II MPNST.
• Radiation therapy confers survival benefit in patients with stage III/IV MPNST.
• A critical tumor size cutoff of 5 cm for predicting patient outcomes was identified.

SummaryObjectivesTo determine the epidemiology and prognostic indicators in patients with malignant peripheral nerve sheath tumors (MPNST) of the head and neck.Materials and methodsThe surveillance, epidemiology, and end results registry was reviewed for patients with head and neck MPNST from 1973 to 2011. Study variables included age, sex, race, tumor size, stage at presentation, and treatment modality.ResultsThere were 374 cases of head and neck MPNST identified. Mean age at diagnosis was 50.7 years; 60.2% of patients were male and 82.6% were white. After diagnosis, 38.8% of patients underwent surgery and radiation therapy and 48.1% underwent surgery alone. Kaplan–Meier analysis demonstrated overall (OS) and disease-specific survival (DSS) of 51% and 67% at 5 years. Multivariate Cox regression analysis showed that age (p = 0.030), stage (p = 0.002), surgery (p = 0.037), and size (p < 0.001) were predictors of OS, while stage (p < 0.001) and size (p < 0.001) were predictors of DSS. For stage I/II cancers, surgery (p = 0.011) and size (p = 0.010) were predictors of OS, and size (p = 0.001) predicted DSS. For stage III/IV cancers, both radiotherapy (p = 0.024, p = 0.009) and size (p = 0.001, p = 0.001) predicted OS and DSS. For tumors ⩽5 cm, stage (p = 0.031) predicted DSS. For tumors >5 cm, male gender (p = 0.005), stage (p = 0.001), surgery (p = 0.003), and radiotherapy (p = 0.050) were determinants of OS, and male gender (p = 0.022), stage (p < 0.001), and radiotherapy (p = 0.002) were determinants of DSS.ConclusionSurgical resection confers survival benefit in patients with early stage MPNST, while radiotherapy improves survival in cases with metastatic disease. Surgery and radiotherapy are prognostically important in patients with tumors >5 cm.