Treatment outcomes and prognostic features in adenoid cystic carcinoma originated from the head and neck
Introduction
Adenoid cystic carcinomas (ACC) of the salivary glands are relatively uncommon head and neck malignancies.[1], [2] Although most of the ACC are of low histological grade, the management of the disease is challenge due to its high tendency of distant metastasis.3 Surgery is considered the mainstay treatment of the disease; however, clear surgical margins are difficult to achieve due to the infiltrative nature of the disease and high probability of perineural invasion of ACC. A number of recently published series have shown that the combination of radiation therapy with surgery could achieve an improved locoregional control.[4], [5], [6], [7], [8], [9] However, the effect of adjuvant radiotherapy on patients’ survival has not been confirmed.
Previous studies have suggested a number of prognostic factors such as stage at diagnosis, the status of regional lymph node metastasis, positive surgical margin, and perineural invasion.[2], [3], [4], [5], [6], [7], [8] However, due to the rarity of this disease, data on patients’ outcome after treatment is relatively limited for ACC. The purpose of this analysis is to evaluate the efficacy of postoperative radiotherapy in the management of ACC of the head and neck, with an attempt to identify significant prognostic indicators of this malignancy after the combined treatment.
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Patient and disease characteristics
Between January 1996 and December 2007, a total of 133 consecutive and non-selected patients with ACC of head and neck were diagnosed and treated at the Fudan University, Shanghai Cancer Center. The medical charts of this group of patients were retrospectively reviewed, and 101 patients who presented without distant metastasis were analyzed in the current series. The characteristics of all patients are detailed in Table 1.
Pretreatment work-up included a complete history and physical
Results
With a median follow-up of 65 months (range 8–156 months), the 5-year locoregional control (LRC) rate was 70.5%. The overall survival (OS), disease-free survival (DFS) and metastasis-free survival (MFS) rates at 5 years were 91.7%, 63.2%, and 83.3%, respectively. Thirty patients experienced locoregional recurrences and five of them had a neck relapse alone. Distant metastases were observed in 14 patients, and the most common site for metastases was lung (13/14).
Gender, age, T-classification,
Discussions
Although surgery is considered as the mainstay treatment modality for adenoid cystic carcinoma (ACC), outcome after radical resection for the disease is far from satisfaction. The disease is characterized by slow progression and late onset of distant metastases, leading to treatment failure. Up to date, the optimal treatment strategy of ACC remains unclear.
Since ACC arising from the head and neck region has high propensity for infiltrating into the adjacent tissue, especially for perineural
Conflict of interest statement
None declared.
References (22)
- et al.
Adenoid cystic carcinoma of salivary origin: a clinicopathologic study of 242 cases
Am J Surg
(1974) - et al.
The influence of positive margins and nerve invasion in adenoid cystic carcinoma of the head and neck treated with surgery and radiation
Int J Radiat Oncol Biol Phys
(1995) - et al.
Risk factors for local recurrence of adenoid cystic carcinoma: the role of postoperative radiation therapy
Am J Otolaryngol
(1999) - et al.
Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: prognostic features of recurrence
Int J Radiat Oncol Biol Phys
(2006) - et al.
Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the major salivary glands: implications for adjuvant therapy
Int J Radiat Oncol Biol Phys
(2007) - et al.
Adenoid cystic carcinoma of the submandibular gland. A 35-year review
Otolaryngol Head Neck Surg
(2004) - et al.
Outcomes and prognostic variables in adenoid cystic carcinoma of the head and neck: a recent experience
Int J Radiat Oncol Biol Phys
(2008) - et al.
Perineural invasion in adenoid cystic carcinoma of the salivary glands: a valid prognostic indicator?
Oral Oncol
(2009) - et al.
Radiotherapy for advanced adenoid cystic carcinoma: neutrons, photos or mixed beams?
Radiother Oncol
(2001) - et al.
Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands
Int J Radiat Oncol Biol Phys
(1996)
Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy
Int J Radiat Oncol Biol Phys
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