Malignant schwannoma of the head and neck

From the Division of Surgical Oncology, University of Illinois College of Medicine at Chicago. Cook County Hospital, and Hektoen Institute for Medical Research, Chicago, Illinois. This work was supported in nart bv the Eleanor B. Pillsburv Fellowshi~Universitv of Illinois HospiLl, aid by the Living Institu~ for %&al Studies Gf the Departm&t of Surgery, University of Illinois College of Medicine at C&ago (KWR). Requests for reprints should be addressed to John A. Greager, II, MD, Division of Su&al Oncology, Cook County Hospital, Room 650, 1835 West Harrison Stmet. Chicago, Illinois 60612. Presented as a poster paper at the 37th Ammal Meeting of the Society of Head and Neck Surgeons, Kaanapali Beach, Hawaii, May l-4,1991. M alignant schwamomas of the head and neck region are rare tumors, for which accurate diagnosis and therapy is frequently delayed [I ,2]. In an attempt to define prognostic characteristics and optimal therapeutic strategies in these patients, we reviewed our 37year experience with this unusual tumor. Seventeen patients were treated for malignant schwannoma of the head and neck between 1953 and 1990 at the University of Illinois and Cook County Hospitals, Chicago, Illinois. There were 10 (59%) females and 7 (41%) males, who ranged in age from 14 to 88 years (mean: 41 years). Twelve (71%) were white, 3 (18%) black, and 2 (11%) Hispanic. A mass was the presenting symptom in nearly all patients, and by far the most common site was the neck. Seven patients had von Recklinghausen’s disease, and there were a variety of other associated conditions (Table I). Histologic diagnosis was based on light and electron microscopy. Tumors were staged according to the method approved by the Joint Commission of the American College of Surgeons [3]. There were seven patients with stage I disease, two with stage III, and eight with stage IV. Primary treatment consisted of surgical excision when feasible. Three patients received adjuvant chemo therapy and radiation. Local failure was treated with radiation and/or chemotherapy, and surgical re-excision was performed when possible. Survival curves were evaluated using the product-limit method, and the Wilcoxon rank-sum test. Survival rates were compared using Fisher’s exact teat, and mean survivals were compared using the independent sample ttest. The 2-, 5, and lo-year disease-free survivals were 47%, 35%, and 24%, respectively, with overall survivals of 651, 47%, and 29%, respectively. Patients with stage I tumors survived longer, on average, than those with more advanced disease (136 versus 60 months, p = 0.07). Patients with grade I tumors had the greatest survival advantage, 129 months compared with 37 months for those with more advanced disease (p = 0.02) (Figure 1, Left). Seven patients in this series had von Recklinghausen’s disease. Five patients who had stage IV disease died less than 2 years after diagnosis. The other two, who had stage I disease, have survived longer than 10 years free of disease (Figure 1, Right). Five of 17 patients (29%) underwent excisional biopsy (grossly negative margins at surgery) without wide excision. The average overall survival for this group was 74 months. Two died of other causes without evidence of disease. The others developed local recurrence, and two subsequently died of their disease. Seven of the 17 patients (42%) underwent wide exci-