Management of Regional Metastases of Malignant Salivary Gland Neoplasms

Medina, Jesús E.; Zbären, Peter; Bradley, Patrick J.

doi:10.1159/000442133

Cited by 6 publications

(9 citation statements)

References 39 publications

(70 reference statements)

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“…In contrast, immunotherapies aim at boosting the anti-tumor immune response of the tumor patient. While conventional cancer immunotherapy strategies so far have had only very limited success [ 6 ], immune checkpoint blockade therapies are very promising new approaches in cancer therapy [ 3 ], [ 4 ], [ 6 ], [ 7 ], [ 30 ], [ 31 ]. Such therapies are designed to restore the patients’ own antitumor immune response that had been mitigated during the processes of tumor immune evasion.…”

Section: Discussionmentioning

confidence: 99%

T-cell epitope strength in WAP-T mouse mammary carcinomas is an important determinant in PD1/PD-L1 immune checkpoint blockade therapy

et al. 2016

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Using the SV40 transgenic WAP-T/WAP-TNP mouse models for mammary carcinomas, we compared the response to immune checkpoint blockade therapy in tumor mice expressing either SV40 T-antigen containing the LCMV NP-epitope (T-AgNP in WAP-TNP mice), or the unmodified T-antigen (T-Ag in WAP-T mice). Specifically, we asked, whether the presence of the highly immunogenic NP-epitope in T-AgNP influences this response in comparison to the weakly immunogenic T-cell epitopes of T-Ag in WAP-T tumor mice. Treatment of WAP-TNP tumor mice with either anti-PD1 or anti-PD-L1 antibodies led to tumor regression, with anti-PD-L1 treatment being more effective. However, tumors had fully re-appeared after 21 days, indicating that CTL exhaustion had been rapidly re-established. Surprisingly, the same treatment applied to WAP-T tumor mice resulted in a significantly prolonged period of tumor regression. We provide evidence that in contrast to the weak antigenic stimuli exerted by T-cell epitopes of T-Ag, the strong antigenic stimulus of the NP-epitope in T-AgNP has a dual effect: (i) a rapid generation of active NP-specific CTLs, accompanied (ii) by accelerated CTL exhaustion. Our data support the hypothesis that the immunogenicity of tumor antigen T-cell epitopes strongly influences the success of immune checkpoint blockade therapy.

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Section: Discussionmentioning

confidence: 99%

T-cell epitope strength in WAP-T mouse mammary carcinomas is an important determinant in PD1/PD-L1 immune checkpoint blockade therapy

et al. 2016

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“…The optimal management of these tumours remains controversial. As Medina et al [15] concluded in their review, given the contradictory data in the literature, the debate remains open. Medina et al discuss how beliefs about the optimal management of the neck have changed in recent decades [15].…”

Section: Discussionmentioning

confidence: 99%

“…As Medina et al [15] concluded in their review, given the contradictory data in the literature, the debate remains open. Medina et al discuss how beliefs about the optimal management of the neck have changed in recent decades [15]. In this regard, regrettably, the findings of our study cannot resolve the ongoing debate.…”

Section: Discussionmentioning

confidence: 99%

Management of clinically negative neck in salivary gland cancers – elective neck dissection, irradiation, or surveillance?

Szewczyk

Golusiński

Pazdrowski

et al. 2019

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Aim of the studyTo retrospectively assess treatment outcomes among patients treated for salivary gland cancers at our institution to determine which of the three most common treatment approaches – elective neck dissection (END), elective neck irradiation (ENI), or observation – provide the best results.Material and methodsA total of 122 patients were identified who had undergone primary surgery for SGC followed by END, ENI, or observation. The patients were classified into three groups according to the treatment approach used to manage the neck: END, ENI, or observation. The main outcome measures were disease-free survival (DFS) and overall survival (OS). We also sought to identify the risk factors potentially associated with neck metastasis and treatment failure.Results106 patients met all inclusion criteria. Of these 106 patients, 27 (25.7%) underwent END, 17 (16.0%) underwent ENI, and 62 (58.5%) observation. There were no statistically significant differences between the three groups in any of the following variables: advanced age (> 70); presence of locally advanced disease (T3 or T4); perineural invasion; lymphovascular invasion; and primary tumour location. Treatment failure was higher (non-significantly) in the END group (25.9%) vs. the observation (21.0%) and ENI (11.8%) groups. No differences (Kaplan-Meir curves) were observed among the three groups in terms of DFS or OS.ConclusionsOur results show that elective neck dissection does not appear to provide any benefit to patients treated for malignant salivary gland cancer. Importantly, these findings contradict most of the currently available research. However, due to methodological differences among the available studies, our findings cannot be compared directly to other studies.

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“…Cervical lymph node metastasis is a negative prognostic factor in patients with salivary gland carcinoma, 1‐6 and therapeutic neck dissection (TND) is recommended in patients with clinically involved cervical lymph nodes 7‐12 . However, there are no universally accepted guidelines on the surgical treatment of patients with clinically negative neck.…”

Section: Introductionmentioning

confidence: 99%

“…Current practice in Denmark is TND in patients with clinically positive cervical lymph nodes, and elective neck dissection (END) is recommended in patients with T3/T4 tumors, high‐grade histology tumors, or in cases of facial nerve palsy 13 . This approach is supported by studies that recommend END in patients with high‐grade histology tumors or advanced tumor classifications 8,11,12,14‐21 . Other studies have recommended END in all patients with salivary gland carcinomas, 22‐26 because preoperative evaluations of histological tumor subtypes and grades are unreliable and there is a risk of regional metastases even for low‐grade histology tumors.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of the neck in patients with salivary gland carcinoma

et al. 2021

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Background Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines. Methods Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence‐free survival was calculated using the Kaplan–Meier method. Results Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high‐grade histology tumors. In multivariate analyses, high‐grade histology and vascular invasion were associated with occult metastases. Conclusion We recommend END of levels II and III for patients with high‐grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.

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Management of Regional Metastases of Malignant Salivary Gland Neoplasms

Cited by 6 publications

References 39 publications

T-cell epitope strength in WAP-T mouse mammary carcinomas is an important determinant in PD1/PD-L1 immune checkpoint blockade therapy

T-cell epitope strength in WAP-T mouse mammary carcinomas is an important determinant in PD1/PD-L1 immune checkpoint blockade therapy

Management of clinically negative neck in salivary gland cancers – elective neck dissection, irradiation, or surveillance?

Surgical treatment of the neck in patients with salivary gland carcinoma

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