Clinicopathological Features and Therapeutic Outcomes of Head and Neck Sarcomas: A 14-Year Retrospective Study

Head and neck sarcomas are rare malignant tumors with a wide histological diversity. Their diagnosis and management remain challenging because of their complex anatomical location and aggressive behavior. The objective of this study was to analyze the epidemiological, clinical, and paraclinical characteristics of head and neck sarcomas over 14 years in a tertiary military hospital, with a focus on survival, recurrence, and treatment response. A retrospective descriptive study was conducted in the ENT Surgery Department of the Military Hospital of Tunis from January 2010 to December 2023. Nineteen patients diagnosed with head and neck sarcomas were included. Data regarding demographics, clinical presentation, imaging, histology, treatment, and outcomes were analyzed. All patients underwent radiological evaluation to determine locoregional and distant tumor extension. Histological diagnosis was obtained by biopsy in 10 cases and from surgical specimens in nine. The study included 10 males and nine females, aged two to 76 years (mean age = 43 years). The most frequent histological subtypes were synovial sarcoma and embryonal rhabdomyosarcoma. Surgery was the main treatment in nine patients, often combined with adjuvant radiotherapy or chemotherapy. Reconstructive surgery using a frontal flap was performed in one case of nasal angiosarcoma. Two patients were treated with concomitant radio-chemotherapy, four received exclusive radiotherapy, and one patient received only chemotherapy. Distant metastases were identified in two cases. The mean follow-up was 24 months (range: two months to five years). Local recurrence occurred in two patients, and four patients experienced disease-related mortality. Head and neck sarcomas require complex and multidisciplinary management. Surgery remains the cornerstone of treatment when feasible, but therapeutic strategies must be individualized based on tumor location, histological type, and extension. Optimizing outcomes depends on early diagnosis and tailored, case-specific multimodal approaches.