Low-Grade Salivary Gland Cancers: Treatment Outcomes, Extent of Surgery and Indications for Postoperative Adjuvant Radiation Therapy

Cho, Jae-Keun; Lim, Byungwoo; Kim, Eunhye; Ko, Young‐Hyeh; Oh, Dongryul; Noh, Jae Myoung; Ahn, Yong Chan; Baek, Kwan-Hyuck; Jeong, Han‐Sin

doi:10.1245/s10434-016-5353-6

Cited by 42 publications

(60 citation statements)

References 22 publications

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“…Richter et al [11] reported on 13 patients with parotid acinic cell carcinoma or MEC with close margins but administered adjuvant radiotherapy to all patients without a comparative group undergoing surgery alone. Similarly, Cho et al [7] reported on the impact of close margins after resection of parotid malignancy in a larger multivariable analysis but did not specifically investigate the effect of radiotherapy on this patient population. Finally, Spellman and Calzada [22] recently analyzed 154 patients with MEC of the head and neck and also found that further treatment of patients with close margins, either revision surgery or radiotherapy, did not significantly impact survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with low-grade malignancies, such as acinic cell carcinoma, low-grade MEC, and polymorphous (low-grade) adenocarcinomas, without high-risk histopathological features, such as advanced T-stage, involved regional nodes, positive margins, and lymphovascular or perineural invasion, may be treated with surgery alone and achieve excellent long-term disease control [2, 6, 7]. Armstrong et al [6] performed a matched-pair analysis of patients with major salivary gland malignancy managed with surgery alone as compared with combined surgery and radiation.…”

Section: Introductionmentioning

confidence: 99%

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Mucoepidermoid Carcinoma of the Parotid: Very Close Margins and Adjuvant Radiotherapy

Zenga

Parikh

et al. 2019

ORL

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Background/Aims: The importance of adjuvant radiotherapy in patients with close margin resections for mucoepidermoid carcinoma of the parotid gland remains unclear. Methods: Patients who underwent parotidectomy for mucoepidermoid carcinoma with or without adjuvant radiotherapy at a single academic tertiary care center from 2000 to 2014 were identified. Included patients had negative but close (≤2 mm) surgical margins without other high-risk histopathological factors including advanced T-stage, positive nodal disease, lymphovascular or perineural invasion, or high-grade histology. Results: Nineteen patients were identified, of whom 15 (79%) were observed postoperatively, while 4 (21%) underwent adjuvant radiotherapy. There were no significant differences in extent of parotidectomy, elective neck dissection, T staging, or tumor size between patients who were observed and those undergoing adjuvant radiation. There were no locoregional or distant recurrences in any patients at a mean follow up 74.3 months. Patients undergoing adjuvant radiation, however, had significantly more intermediate-grade as compared to low-grade histology (75% vs. 13%, difference 62%, 95% CI 4% to 100%). Conclusions: Patients with negative but close (≤2 mm) surgical margins without other high-risk histopathological factors have excellent long-term locoregional control with surgery alone. The effects of adjuvant radiotherapy for those who have intermediate-grade disease remain uncertain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mucoepidermoid Carcinoma of the Parotid: Very Close Margins and Adjuvant Radiotherapy

Zenga

Parikh

et al. 2019

ORL

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“…Low-grade SGCs have excellent treatment outcomes, with 5-year overall survival (OS) rates of >90% [14], whereas high-grade SGCs have a significantly higher distant metastasis rate and poor outcomes, with 5-year survival rates of <50% [8,[15][16][17]. Therefore, histological grade is one of the most important factors affecting the treatment strategy for SGC patients.…”

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confidence: 99%

“…Therefore, histological grade is one of the most important factors affecting the treatment strategy for SGC patients. Early-stage lowgrade SGCs without pathological risk factors such as perineural invasion (PNI), lymphovascular invasion (LVI), and extraparenchymal extension (EPE) are not associated with a high risk of recurrence following surgery without postoperative radiotherapy (RT); furthermore, for such cases, partial, rather than total, resection of the affected gland is sufficient if the resection margin is clear from tumor cells [14,18]. For high-grade SGCs, even early-stage tumors should be subjected to postoperative RT after complete surgical resection [19].…”

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confidence: 99%

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Survival Outcome of Intermediate-Grade Salivary Gland Carcinoma

Park

Roh²,

Cho³

et al. 2017

Oncology

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Objective: Histological grade is the most important factor for defining treatment strategies and predicting prognosis for salivary gland carcinoma (SGC). We examined factors affecting long-term recurrence and survival among intermediate-grade SGC (IGSGC) patients to define optimal treatment modalities and outcomes. Methods: We reviewed the clinical and pathological data on 108 IGSGC patients who underwent definitive surgery with or without postoperative radiotherapy. We compared treatment outcomes by treatment strategies such as surgical extent for the primary tumor, neck dissection, or postoperative radiotherapy. Results: During a 103-month median follow-up, local, regional, and distant recurrences were detected in 14 (13.0%), 3 (2.8%), and 21 (19.4%) patients, respectively. The 10-year locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 83.1, 76.0, and 80.1%, respectively. Multivariate analyses identified a nonparotid primary site as an independent prognostic factor for LRC (p = 0.018). Adenoid cystic carcinoma and a positive pN classification were significantly unfavorable prognostic factors for DMFS (p = 0.025 and p = 0.030, respectively); overall advanced stage was an independent prognostic factor for OS (p = 0.020). Surgical extent, elective neck dissection, and postoperative adjuvant radiotherapy did not significantly affect treatment outcomes. Conclusion: Patients with early-stage IGSGC of parotid origin can achieve favorable treatment outcomes with conservative surgery alone.

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Close Margins and Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Parotid Gland

Zenga

Parikh

Emerick

et al. 2018

JAMA Otolaryngol Head Neck Surg

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Low-Grade Salivary Gland Cancers: Treatment Outcomes, Extent of Surgery and Indications for Postoperative Adjuvant Radiation Therapy

Abstract: Postoperative radiation clearly benefitted patients with pathology risk factors, node metastasis, and advanced T stage in LGSGC. Meanwhile, the oncological outcomes are very good with surgery alone in cases of pT1-2N0 LGSGC without pathology risk factors.

Cited by 42 publications

References 22 publications

Mucoepidermoid Carcinoma of the Parotid: Very Close Margins and Adjuvant Radiotherapy

Mucoepidermoid Carcinoma of the Parotid: Very Close Margins and Adjuvant Radiotherapy

Survival Outcome of Intermediate-Grade Salivary Gland Carcinoma

Close Margins and Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Parotid Gland

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