Adenoid Cystic Carcinoma of the Head and Neck

Abstract

Combined treatment yielded an 85% locoregional freedom from relapse and disease-specific survival at 5, 10, and 15 years was 89%, 67.4%, and 39.6%, respectively. Thirty-five patients (21.9%) had distant metastases as the only site of failure. Patients treated for paranasal sinus tumor experienced the most treatment-related morbidity vs other sites. Perineural invasion of major nerves, positive margins at surgery, and solid histological features were associated with increased treatment failures. Four or more symptoms present at diagnosis, positive lymph nodes, solid histology, and perineural invasion of major nerves were associated with increased mortality from disease.

Loss of heterozygosity at chromosome 6q23–25 correlates with clinical and histologic parameters in salivary gland adenoid cystic carcinoma

“…Indeed in this study, LOH rates are significantly higher in cribriform tumor tissue of patients with >10% versus <10% solid tumor growth, whereas LOH rates in cribriform primaries of patients with >30% versus <30% solid tumor growth do not differ significantly. Our observation that low LOH rates are restricted to patients with <10% solid growth pattern is interesting with respect to the observations of Szanto et al [30] and Fordyce et al [3] that a favorable course is restricted to patients with <10% solid growth pattern.…”

“…ACCs with a solid growth pattern have a worse prognosis than those with a cribriform or tubular growth pattern; however, the extent of solid component required to classify a tumor as a high-grade lesion is a matter of debate [30,18,27,3]. While some authors claim that only tumors lacking a solid growth pattern have a better prognosis [30], others studies have documented a less favorable course in patients with more than 10% solid areas [3] and more than 30% solid areas, respectively [18]. Compared to the cribriform subtype, the more aggressive solid subtype is characterized by a relatively high incidence of aneuploidy, a higher dividing cell fraction, and an increase in the number of nucleolar organizer regions (AgNORs) [23,4,38].…”

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.…”

Chemoradiotherapy for Adenoid Cystic Carcinoma

“…Standard treatment has been surgical resection, followed by radiotherapy to encompass the nerve pathways up to and including base of skull. [5][6][7] With this strategy local recurrences are significantly reduced.…”

“…5,6 Primary radiotherapy data is less convincing, most likely because of selection bias, which has reserved radiotherapy for patients with the most advanced or unresectable disease or with significant medical comorbidities. Local regional control with primary modern photon based radiotherapy or neutron beam radiotherapy is reported to be 56% and 57% at 5 years, respectively.…”