Kimura Yutaro, Tomihara Kei, Tachinami Hidetake, Imaue Shuichi, Nakamori Kenji, Fujiwara Kumiko, Suzuki Kayo, Yasuda Taketoshi, Miwa Shigeharu, Nakayama Eiji, Noguchi Makoto
Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, 2630 Sugitani, Toyama city, Toyama, 930-0194, Japan.
Department of Oral and Maxillofacial Surgery, Naha City Hospital, 2-31-1 Furujima, Naha, Okinawa, 902-8511, Japan.
J Med Case Rep. 2017 Aug 2;11(1):210. doi: 10.1186/s13256-017-1386-0.
Osteosarcoma, the most common primary bone malignancy, has an extremely poor prognosis and a high rate of local recurrence and distal metastases. Because osteosarcomas of the head and neck region are rare, accounting for less than 10% of all osteosarcoma cases, limited information is available about their treatment and prognosis. Because of the high rate of distal metastases associated with extragnathic osteosarcoma, surgery combined with chemotherapy is currently considered essential in its treatment. However, the role of chemotherapy has not been well elucidated in the treatment of head and neck osteosarcoma because of the rarity of this condition.
In this report, we present the case of a 58-year-old Japanese woman with osteosarcoma of the mandible that was treated with radical surgery combined with neoadjuvant and adjuvant chemotherapy. Because the tumor showed rapid growth during neoadjuvant chemotherapy, neoadjuvant chemotherapy was suspended and surgical resection was performed, followed by adjuvant chemotherapy. No evidence of local recurrence and distal metastasis was found 14 months after initial treatment. Local control is considered a principal prognostic factor for head and neck osteosarcoma.
Wide surgical excision should be considered a primary goal even during neoadjuvant chemotherapy, especially in cases that respond poorly to neoadjuvant chemotherapy.
骨肉瘤是最常见的原发性骨恶性肿瘤，预后极差，局部复发率和远处转移率高。由于头颈部骨肉瘤罕见，占所有骨肉瘤病例的比例不到10%，因此关于其治疗和预后的信息有限。由于颌骨外骨肉瘤的远处转移率高，目前认为手术联合化疗是其治疗的关键。然而，由于这种情况罕见，化疗在头颈部骨肉瘤治疗中的作用尚未得到充分阐明。
在本报告中，我们介绍了一名58岁日本女性下颌骨肉瘤患者的病例，该患者接受了根治性手术联合新辅助化疗和辅助化疗。由于肿瘤在新辅助化疗期间生长迅速，新辅助化疗暂停并进行了手术切除，随后进行辅助化疗。初始治疗14个月后未发现局部复发和远处转移迹象。局部控制被认为是头颈部骨肉瘤的主要预后因素。
即使在新辅助化疗期间，也应将广泛的手术切除视为主要目标，尤其是对新辅助化疗反应不佳的病例。
