Adenoid cystic carcinoma: A retrospective clinical review

Abstract

SUMMARY Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were identified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer's criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recurrence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was significantly associated with increasing stage. No other variables were predictive for recurrence. Additionally, we found that nasosinal tumors were more likely to display higher stage at presentation, and were more often associated with perineural invasion.

Adenoid cystic carcinoma: A review of recent advances, molecular targets, and clinical trials

“…Risk factors for the development of distant metastases are similar to the local recurrence risk factors above, with the additions of solid histology, size over 3 cm, and involvement of regional lymph nodes 1, 5, 38, 44, 45. The most common sites of metastases are the lungs followed by bone, liver, skin, breast, and rarely the brain 44.…”

“…Other sites of origin in the head and neck are the tongue, paranasal sinuses, palate, nasopharynx, lacrimal glands, and external auditory canal. ACC may also arise in secretory glands located in other tissues, such as in the tracheobronchial tree, esophagus, breast, lungs, prostate, uterine cervix, Bartholin's glands, and vulva 4, 5. The disease is seen most commonly in the fifth and sixth decades of life but may appear at almost any age 1, 6.…”

“…Recent data also suggests intraneural, rather than perineural, invasion has a larger impact on survival in head and neck ACC 41. Other parameters that correlate with local recurrence after surgery are age, nonsalivary or minor salivary gland primary, T classification, tumor grade, lymphovascular invasion, and positive surgical margins 5, 11, 38, 42, 43…”

Biologic and therapeutic role of HER2 in cancer

“…The highest frequency of HER2 overexpression is found in inflammatory breast cancers scoring 3 þ with herceptest in more than 60% of the cases (Tagliabue et al, 1998), followed by Wilm's tumor (50%), bladder cancer (44%), and noninflammatory breast cancer (25%). In other tumors, including pancreatic, colon, ovary, and lung tumors, the frequency of HER2 overexpression differs in different reports and is often greater than predicted by gene-amplification data (Kim et al, 2000;Geddert et al, 2002;Goebel et al, 2002;Hirsch et al, 2002;Khan et al, 2002;Latif et al, 2002;Soule et al, 2002;Yan et al, 2002;Nakamura et al, 2003), suggesting that overexpression in these tumors is due to gene deregulation rather than gene amplification. New therapeutic tools targeting HER2 are now being investigated mainly for therapy of breast carcinomas, in which overexpression is mainly due to gene amplification.…”

Analysis and significance of c-MET expression in adenoid cystic carcinoma of the salivary gland

“…1,2 Despite undergoing resection with clear margins, up to 60% of patients have locoregional or distant recurrence. The median survival duration of patients with distant metastases is about 3 years, although up to 10% of these patients may survive 10 y or longer with indolent metastases.…”