Elsevier

Oral Oncology

Volume 48, Issue 5, May 2012, Pages 445-449
Oral Oncology

Treatment outcomes and prognostic features in adenoid cystic carcinoma originated from the head and neck

https://doi.org/10.1016/j.oraloncology.2011.12.002Get rights and content

Summary

Surgery is the main treatment modality for adenoid cystic carcinoma (ACC) originated from the head and neck. However, the extensive local infiltrative and perineural spread related to this malignancy often cause difficulty to achieve high tumor control. The aim of this study is to evaluate the efficacy of postoperative radiotherapy (RT) in ACC, and to identify prognostic variables associated with treatment outcomes. A retrospective review of 101 patients diagnosed with ACC in the head and neck region was performed. T stage distribution was T1, 25; T2, 35; T3, 18; and T4, 23 patients. All patients were grouped into two arms: surgery alone or combined with postoperative radiotherapy. The 5-year local–regional control (LRC), overall survival (OS) and disease-free survival (DFS) rates for all the patients were 70.5%, 91.7% and 63.2%, respectively. On univariant analysis, postoperative radiotherapy did improve the 5-year LRC and DFS compared to surgery alone (81.0% vs. 53.4%, p = 0.0003 and 71.3% vs. 50.0%, p = 0.0052, respectively). And patients with T1–T2 lesions achieved better treatment outcomes, whereas stage T3–T4 was associated with high local failure and poor disease-free survival. Furthermore, multivariate analysis revealed that the addition of radiotherapy and early lesions were both favorite predictors for local control and survival rates. The prognosis for ACC of the head and neck was excellent. Surgery combined with postoperative radiotherapy significantly reduced the local failure, and further improved disease-free survival. Nevertheless, the relatively high distant metastasis was an obstacle of curing the ACC patients.

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.

Section snippets

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.

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