Late recurrence from salivary gland cancer

Abstract

BACKGROUND.The purpose of the current study was to determine the incidence of late recurrences, which were defined as those occurring ≥5 years after initial therapy, among patients treated for salivary gland cancer.METHODS.Between 1960 and 2000, 145 patients underwent definitive therapy for localized carcinomas of the salivary glands and were clinically without evidence of disease at 5 years of follow‐up. Cumulative probabilities for developing a subsequent late recurrence were estimated using the Kaplan‐Meier method.RESULTS.The 10‐year and 15‐year cumulative probabilities of late recurrence in patients who were free of disease at 5 years were 13% and 18%, respectively. The crude rates of late recurrence by histologic subtype were adenoid cystic carcinoma (26%), mixed malignant tumor (25%), mucoepidermoid carcinoma (17%), adenocarcinoma (10%), and acinic cell carcinoma (8%). Sites of late recurrence included distant metastasis (17 patients), local recurrence (8 patients), and regional recurrence (2 patients). The median time to late recurrence was 7.1 years (range, 5.2–23.1 years) from the date of initial surgery. Salvage treatment varied according to location of disease recurrence and initial treatment characteristics. The 15‐year estimate of overall survival was 39% for patients who experienced a late recurrence compared with 71% for those who remained free of disease (P = .001).CONCLUSIONS.A significant proportion of patients who are presumed to be cured of their disease at 5 years after initial treatment for salivary gland cancer will be found to develop late disease recurrence with additional follow‐up. Cancer 2008. © 2007 American Cancer Society.

Use of the Word “Cure” in Oncology

“…With anecdotal knowledge of patients who experienced late relapses, oncologists may not consider 5-year-and sometimes even 10-year-survival rates to adequately predict whether a specific patient is cured. 7,8 Nonetheless, in the cases that were presented in this survey, close to 90% of clinicians indicated that certain patients were cured 20 years after treatment. It is unclear whether the clinicians would have told the patients in these case studies that they are cured.…”

Concurrent chemoradiation for adenoid cystic carcinoma of the head and neck

“…[11][12][13] However, beneficial effect of postoperative treatment on survival is less clear, partly because successful surgical salvage is frequently possible after locoregional failure and also because survival is related to the high risk for development of distant metastasis, which may be unrelated to locoregional control. Postoperative radiation has been reported to improve locoregional control and is, therefore, commonly used for most cases excepting the very early lesions resected with clearly adequate margins and absence of perineural invasion.…”

Assessment of angiogenesis by CD105 antigen in epithelial salivary gland neoplasms with diverse metastatic behavior

“…In an effort to investigate possible association between formation of new blood vessels and development of metastasis in salivary gland tumors, the present work investigated the most frequent of these lesions (PA) as a conceptual standard for non-metastasizing disease, as well as three of the most important malignant neoplasms for which metastasis is possible, but less (PLGA) or more (ACC, MEC) frequent [16,17]. These lesions also diverge regarding to differentiation and myoepithelial content [18].…”