Adjuvant Radiation Therapy for High-Grade and/or Locally Advanced Major Salivary Gland Tumors

Mahmood, Usama; Koshy, Matthew; Goloubeva, Olga; Suntharalingam, Mohan

doi:10.1001/archoto.2011.158

Cited by 77 publications

(77 citation statements)

References 22 publications

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“…This survival effect was observed only in multivariate analysis after accounting for the other covariates. Interestingly, our result is numerically similar to the HR reported by Mahmood et al for major salivary gland tumors [17].…”

Section: Discussionsupporting

confidence: 92%

“…Survival benefit for adjuvant RT was limited to the highest risk group with P(T|X) (0.67, 1). These results are in agreement with previously reported results for major salivary gland tumors [17]. We believe that such an approach allows for an unbiased way to estimate the patient's risk and can assist the treating physicians to decide whether adjuvant RT is warranted in individual cases.…”

Section: Discussionsupporting

confidence: 92%

“…A matched paired analysis from the Memorial Sloan Kettering Cancer Center showed improved survival with adjuvant RT for stage III-IV and node positive major salivary gland tumors. Adjuvant radiation was also associated with improved survival for high grade or locally advanced major salivary gland tumors in a recent SEER analysis [17]. As shown in Table 2, adjuvant RT had a favorable mortality HR of 0.76 as compared to surgery alone.…”

Section: Discussionmentioning

confidence: 91%

See 2 more Smart Citations

Survival benefit for adjuvant radiation therapy in minor salivary gland cancers

Zeidan

Pekelis

et al. 2015

Oral Oncology

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

Survival benefit for adjuvant radiation therapy in minor salivary gland cancers

Zeidan

Pekelis

et al. 2015

Oral Oncology

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“…The largest study completed regarding adjuvant RT for SGCs investigated 2170 patients from the Surveillance, Epidemiology, and End Results (SEER) registry. They found that postoperative adjuvant RT is associated with improved overall survival for high-risk disease (defined as poorly differentiated, undifferentiated, and/or locally advanced T3/4 or N+) 5 . Another SEER database study, however, investigated 1241 cases of parotid acinic cell carcinoma and found that adjuvant RT did not provide a tangible overall survival benefit in this population 6 .…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiation for salivary gland malignancies is associated with improved survival: A National Cancer Database analysis

Bakst

Özbek

et al. 2017

Advances in Radiation Oncology

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ObjectiveThere are no randomized data to support the use of postoperative radiation for salivary gland malignancies. This study uses the National Cancer Database (NCDB) to describe the epidemiology of salivary gland cancer patients and to investigate whether treatment with adjuvant radiation improves overall survival.Methods and materialsA total of 8243 patients diagnosed with a major salivary gland cancer were identified from the NCDB. All patients received primary surgical resection of their malignancy. Patients were risk-stratified by adverse features, and overall survival rates were determined. Patients were considered high risk if they had extracapsular extension and/or positive margin after resection. Patients were considered intermediate risk if they did not meet the criteria for high risk but had pT3-T4 disease, pN+ disease, lymphovascular space invasion, adenoid cystic histology, or grade 2-3 disease. Patients who did not meet criteria for high or intermediate risk were considered low risk. Overall patient demographics, disease characteristics, treatment factors, and outcomes were summarized with descriptive statistics and analyzed with STATA.ResultsMedian follow-up in this cohort was 42.4 months, with the median age of 58 years. Patients in the high-risk group had greater survival (hazard ratio [HR], 0.76; P = .002; 95% confidence interval [CI], 0.64-0.91) if they received adjuvant radiation therapy. In contrast, patients in the intermediate- (HR, 1.01; P = .904; 95% CI, 0.85-1.20) and low-risk groups (HR, 0.85; P = .427; 95% CI, 0.57-1.26) did not experience a survival benefit with adjuvant radiation therapy.ConclusionsThis large analysis compared survival outcomes between observation and adjuvant radiation alone in risk-stratified patients after resection of major salivary glands using a national database. The use of adjuvant radiation for high-risk major salivary gland cancers appears to offer a survival benefit. Although an overall survival benefit was not seen in low- and intermediate-risk salivary gland cancers, this study could not address impact on local control because of the limitations of the NCDB.

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“…MSGC encompass a cohort of histologies, of which the most common cancer is mucoepidermoid carcinoma, followed by adenoid cystic carcinomas and acinar cell neoplasms, and the most common site of involvement is the parotid gland. Because of the histological heterogeneity and biological behavior diversity, surgery-related issues and the role of radiation therapy were disordered [3, 4], and the 5-year overall survival (OS) rates of MSGC patient vary widely, ranging from 32% to 74% [5, 6]. In addition, since MSGC is rare, most reports of clinical prognostic factors, OS, and cancer-specific survival (CSS) are from small single-institution retrospective studies [5–8].…”

Section: Introductionmentioning

confidence: 99%

Nomograms for predicting long-term overall survival and cancer-specific survival in patients with major salivary gland cancer: a population-based study

Liu

et al. 2017

Oncotarget

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In this study, we aimed to develop and validate nomograms for predicting long-term overall survival (OS) and cancer-specific survival (CSS) in major salivary gland cancer (MSGC) patients. These nomograms were developed using a retrospective cohort (N=4218) from the Surveillance, Epidemiology, and End Results (SEER) database, and externally validated using an independent data cohort (N=244). We used univariate, and multivariate analyses, and cumulative incidence function to select the independent prognostic factors of OS and CSS. Index of concordance (c-index) and calibration plots were used to estimate the nomograms’ predictive accuracy. The median follow-up period was 34 months (1–119 months). Of 4218 MSGC patients, 1320 (31.3%) died by the end of the follow-up; of these 1320 patients, 883 (20.9%) died of MSGC. The OS nomogram, which had a c-index of 0.817, was based on nine variables: age, sex, tumor site, tumor grade, surgery performed, radiation therapy and TNM classifications. The CSS nomogram, which had a c-index of 0.829, was based on the same nine variables plus race. External validation c-indexes were 0.829 and 0.807 for OS and CSS, respectively. Based on SEER database, we have developed nomograms predicting five- and eight-years OS and CSS for MSGC patients with perfect accuracy. These nomograms will help clinicians customize treatment and monitoring strategies in MSGC patients.

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Adjuvant Radiation Therapy for High-Grade and/or Locally Advanced Major Salivary Gland Tumors

Abstract: Adjuvant RT is associated with improved survival for high-grade and/or locally advanced MMSGT based on analysis of this large, population-based database. Further prospective studies are warranted to examine the role of RT in the management of this disease.

Cited by 77 publications

References 22 publications

Survival benefit for adjuvant radiation therapy in minor salivary gland cancers

Survival benefit for adjuvant radiation therapy in minor salivary gland cancers

Adjuvant radiation for salivary gland malignancies is associated with improved survival: A National Cancer Database analysis

Nomograms for predicting long-term overall survival and cancer-specific survival in patients with major salivary gland cancer: a population-based study

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