No abstract

Background. The purpose of this study was to analyze the results of radiotherapy (RT) alone or combined with surgery for adenoid cystic carcinoma.Methods. Between September 1966 and November 2001, 101 previously untreated patients were treated with curative intent with RT alone or combined with surgery. Follow-up ranged from 0.4 to 30.6 years (median, 6.6 years). All living patients had follow-up for at least 1 year.Results. The 5-and 10-year rates of local control were as follows: RT alone, 56% and 43%; surgery and RT, 94% and 91%; and overall, 77% and 69%. Multivariate analysis of local control revealed that T stage ( p = .0101) and treatment group ( p = .0008) significantly influenced this endpoint. The 5-and 10-year rates of distant metastases-free survival were 80% and 73%. The 5-and 10-year absolute survival rates were as follows: RT alone, 57% and 42%; surgery and RT, 77% and 55%; and overall, 68% and 49%. Multivariate analysis of absolute survival revealed that T stage ( p = .0043) and clinical nerve invasion ( p = .0011) significantly influenced this endpoint. The 5-and 10-year causespecific survival rates were as follows: RT alone, 65% and 48%; surgery and RT, 81% and 71%; and overall, 74% and 61%. Multivariate analysis revealed that T stage ( p = .0008) and clinical nerve invasion ( p = .0005) significantly influenced causespecific survival.Conclusions. The optimal treatment for patients with adenoid cystic carcinoma is surgery and adjuvant RT. A significant proportion of patients with incompletely resectable disease are cured after RT alone. Improvements in locoregional control are offset, in part, by the relatively high incidence of distant metastases.

Diagnostic evaluation should include a thorough physical examination, CT and/or MRI of the head and neck, and panendoscopy with directed biopsies. Unilateral or bilateral tonsillectomy should be performed on patients with adequate lymphoid tonsillar tissue. FDG-PET or FDG-PET/CT should be considered for those with indeterminate findings on physical examination and/or head and neck CT and/or MRI if those sites are located outside of the oropharynx.