Management of adenoid cystic carcinoma of the head and neck: a single-institute study with over 25-year follow-up

Abstract

Background: Adenoid cystic carcinoma is a rare malignant tumor arising from exocrine glands such as the major and minor salivary glands of the paranasal sinuses or the external auditory canal. Although multiple retrospective clinical studies of ACC have been reported to date, clinical questions, such as 1) long-term prognosis beyond 20 years, 2) usefulness and suitability for treatment of therapeutic interventions, 3) therapeutic goal to aim for, and 4) prognosis by recurrence sites, are still unclear. Methods: To improve understanding and management of adenoid cystic carcinoma of the head and neck (ACC), a retrospective study with 58 new ACC cases between 1991 and 2016 was performed. The median observation period was 66.8 months (range 3-316 months). The overall clinical stages were as follows: I, 6.9%; II, 25.9%; III, 19.0%; and IV, 48.2%. Histology was cribriform/tubular type (C-T type) in 62.0% and solid type in 27.5%. The main treatment strategy was definitive surgery, which was performed in 75.2% of cases.

An Overview on the Histogenesis and Morphogenesis of Salivary Gland Neoplasms and Evolving Diagnostic Approaches

“…Given its high recurrence, it has a very poor prognosis due to its metastatic capability and associated perineural invasion. Current treatment protocols involve surgery, followed by post-operative radiotherapy (PORT), which have been fairly successful [63]. PORT has shown to be an effective adjuvant to surgery and to minimize the incidence of recurrence [64].…”

Expression of apoptotic protease activating factor-1 in adenoid cystic carcinoma of the salivary glands and its clinicopathological relevance

“…According to the latest reports, the survival rates following surgical removal of ACC is 70% after 5 years and 60% after 10 years 3,4 .…”

“…While ACC may develop in all salivary glands, it is mainly located in the minor salivary glands, usually in the palate. Slow growth, extensive local invasion, perineural spread, and the late development of distant metastases are characteristic of adenoid cystic carcinoma 3,4,5 .…”

CT-guided palladium-103 seed brachytherapy for metastatic adenoid cystic carcinoma: a retrospective study to assess initial safety and effectiveness of percutaneous CT fluoroscopy-guided permanent seed brachytherapy

“…Retrospective clinical studies of ACC have been published, but data documenting superiority of one treatment modality over another and prognosis beyond 20 years post-treatment are lacking. Initial and repeated surgical treatment of both primary and metastatic ACC lesions has demonstrated longer survival, although judgment of cure 'is almost impossible' due to the indolent course of the disease [28].…”