Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the major salivary glands: Implications for adjuvant therapy

• Published in: International journal of radiation oncology, biology, physics Vol. 67; no. 4; pp. 982 - 987
• Main Authors: Chen, Allen M., M.D, Granchi, Phillip J., M.D, Garcia, Joaquin, M.D, Bucci, M. Kara, M.D, Fu, Karen K., M.D, Eisele, David W., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.03.2007
• Subjects: Adjuvant therapy; Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Carcinoma - secondary; Carcinoma - surgery; CARCINOMAS; Female; HEAD; Head and neck cancer; HEALTH HAZARDS; Hematology, Oncology and Palliative Medicine; HISTOLOGY; Humans; IRRADIATION; LYMPH NODES; Male; METASTASES; Middle Aged; NECK; Neoplasm Recurrence, Local; Neoplasm Staging; PATIENTS; Postoperative radiation; Proportional Hazards Models; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Adjuvant; Salivary gland; Salivary Gland Neoplasms - pathology; Salivary Gland Neoplasms - surgery; SALIVARY GLANDS; SURGERY; Survival Analysis; Salivary gland; Head and neck cancer; Postoperative radiation; Surgery; Adjuvant therapy
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2006.10.043

Purpose: To determine factors predictive of local-regional recurrence (LRR) after surgery alone for carcinomas of the major salivary glands in an attempt to evaluate the potential role of postoperative radiation therapy. Methods and Materials: Between 1960 and 2004, 207 patients with carcinomas of the major salivary glands were treated with definitive surgery without postoperative radiation therapy. Histology was: 67 mucoepidermoid (32%), 50 adenoid cystic (24%), 34 acinic cell (16%), 23 malignant mixed (11%), 16 adenocarcinoma (8%), 6 oncocytic (3%), 6 myoepithelial (3%), and 5 other (2%). Distribution of pathologic T-stage was: 54 T1 (26%), 83 T2 (40%), 46 T3 (22%), and 24 T4 (12%). Sixty patients (29%) had microscopically positive margins. Median follow-up was 6.1 years (range, 0.5–18.7 years). Results: The 5-year and 10-year estimates of local-regional control were 86% and 74%, respectively. A Cox proportional hazard model identified pathologic lymph node metastasis (hazard ratio [HR], 4.8; p = 0.001), high histologic grade (HR, 4.2; p = 0.003), positive margins (HR, 2.6; p = 0.03), and T3–4 disease (HR, 2.0; p = 0.04) as independent predictors of LRR. The presence of any one of these factors was associated with 10-year local-regional control rates of 37% to 63%. Conclusion: Lymph node metastasis, high tumor grade, positive margins, and T3–4 stage predict for significant rates of LRR after surgery for carcinomas of the major salivary glands. Postoperative radiation therapy should be considered for patients with these disease characteristics.