Mucoepidermoid Carcinoma: A 23‐Year Experience with Emphasis on Low‐Grade Tumors with Close/Positive Margins

Spellman, Joseph; Calzada, Gabriel

doi:10.1177/0194599817751072

Cited by 9 publications

(15 citation statements)

References 23 publications

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“…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. These authors, however, included a more heterogenous group of tumors, from sites other than parotid as well as advanced-stage disease, and grouped both close and positive margins for analysis, without identifying radial margin distance.…”

Section: Discussionmentioning

confidence: 99%

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%

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

Zenga

Parikh

et al. 2019

ORL

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“…Mucoepidermoid carcinoma is the most common type of malignancies originating from major salivary gland. Despite of its relatively low incidence, the clinical behavior of MEC differs tremendously, from slow growing indolent tumor with a generally good prognosis to aggressive tumor accompanied with distant metastasis and causing high mortality rate 7, 17, 18. Treatment strategies of MEC evolve as time goes by.…”

Section: Discussionmentioning

confidence: 99%

“…Jegadeesh et al reported that in parotid MEC, no adjuvant radiation and older age at diagnosis were associated with increased risk of local regional recurrence, underlining the essentiality of postoperative radiotherapy 20. Spellmen et al, on the other hand, argued that in low-grade MEC, additional treatment had no impact on survival or recurrence 17. Inconsistencies like this arise widely among existent researches, challenging the management of MaSG-MEC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nomograms for Predicting Overall Survival and Cancer-Specific Survival of Patients with Major Salivary Gland Mucoepidermoid Carcinoma

Shi

et al. 2019

J. Cancer

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Background: The aim of this study was to develop and validate prognostic nomograms predicting overall (OS) and cancer-specific survival (CSS) of patients with major salivary gland (MaSG) mucoepidermoid carcinoma (MEC). Methods: 1398 MaSG-MEC patients were identified from the Surveillance, Epidemiology and End Results (SEER) database. They were randomly and equally divided into a training cohort (n=699) and a validation cohort (n=699). The best subsets of covariates were identified to develop nomograms predicting OS and CSS based on the smallest Akaike Information Criterion (AIC) value in the multivariate Cox models. The nomograms were internally and externally validated by the bootstrap resampling method. The predictive ability was evaluated by Harrell's Concordance Index (C-index). Results: For the training cohort, eight (age at diagnosis, tumor grade, primary site, surgery, radiation, T, N and M classification) and seven predictors (all the above factors except primary site) were selected to create the nomograms estimating the 3- and 5- year OS and CSS, respectively. C-index indicated better predictive performance of the nomograms than the 7th AJCC staging system, which was confirmed by both internal ( via the training cohort: OS: 0.888 vs 0.785, CSS: 0.938 vs 0.821) and external validation ( via the validation cohort: OS: 0.844 vs 0.743, CSS: 0.882 vs 0.787). The calibration plots also revealed good agreements between the nomogram-based prediction and observed survival. Conclusions: We have proposed and validated the nomograms predicting OS and CSS of MaSG-MEC. They are proved to be of higher predictive value than the AJCC staging system and may be adopted in future clinical practice.

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“…15 Histologic grades were categorized according to the classification for head and neck salivary gland cancers established by the World Health Organization. 2 16 Surgical margins from pathology reports were classified as R0 (negative margin), R1 (microscopically positive margin), or R2 (macroscopically positive margin). R0 was further subclassified into clear margins (>1 mm) or close margins (≤1 mm).…”

Section: Meaningmentioning

confidence: 99%

Oncologic Safety of Close Margins in Patients With Low- to Intermediate-Grade Major Salivary Gland Carcinoma

Sajisevi,

Nguyen,

Callas

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportancePostoperative radiation therapy for close surgical margins in low- to intermediate-grade salivary carcinomas lacks multi-institutional supportive evidence.ObjectiveTo evaluate the oncologic outcomes for low- and intermediate-grade salivary carcinomas with close and positive margins.Design, Setting, and ParticipantsThe American Head and Neck Society Salivary Gland Section conducted a retrospective cohort study from 2010 to 2019 at 41 centers. Margins were classified as R0 (negative), R1 (microscopically positive), or R2 (macroscopically positive). R0 margins were subclassified into clear (&gt;1 mm) or close (≤1 mm). Data analysis was performed from June to October 2023.Main Outcomes and MeasuresMain outcomes were risk factors for local recurrence.ResultsA total of 865 patients (median [IQR] age at surgery, 56 [43-66] years; 553 female individuals [64%] and 312 male individuals [36%]) were included. Of these, 801 (93%) had parotid carcinoma and 64 (7%) had submandibular gland carcinoma, and 748 (86%) had low-grade tumors and 117 (14%) had intermediate-grade tumors, with the following surgical margins: R0 in 673 (78%), R1 in 168 (19%), and R2 in 24 (3%). Close margins were found in 395 of 499 patients with R0 margins (79%), for whom margin distances were measured. A total of 305 patients (35%) underwent postoperative radiation therapy. Of all 865 patients, 35 (4%) had local recurrence with a median (IQR) follow-up of 35.3 (13.9-59.1) months. In patients with close margins as the sole risk factor for recurrence, the local recurrence rates were similar between those who underwent postoperative radiation therapy (0 of 46) or observation (4 of 165 [2%]). Patients with clear margins (n = 104) had no recurrences. The local recurrence rate in patients with R1 or R2 margins was better in those irradiated (2 of 128 [2%]) compared to observed (13 of 64 [20%]) (hazard ratio [HR], 0.05; 95% CI, 0.01-0.24). Multivariable analysis for local recurrence found the following independent factors: age at diagnosis (HR for a 10-year increase in age, 1.33; 95% CI, 1.06-1.67), R1 vs R0 (HR, 5.21; 95% CI, 2.58-10.54), lymphovascular invasion (HR, 4.47; 95% CI, 1.43-13.99), and postoperative radiation therapy (HR, 0.10; 95% CI, 0.04-0.29). The 3-year local recurrence-free survivals for the study population were 96% vs 97% in the close margin group.Conclusions and RelevanceIn this cohort study of patients with low- and intermediate-grade major salivary gland carcinoma, postoperative radiation therapy for positive margins was associated with decreased risk of local recurrence. In isolation from other risk factors for local recurrence, select patients with close surgical margins (≤1 mm) may safely be considered for observation.

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Mucoepidermoid Carcinoma: A 23‐Year Experience with Emphasis on Low‐Grade Tumors with Close/Positive Margins

Cited by 9 publications

References 23 publications

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

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

Prognostic Nomograms for Predicting Overall Survival and Cancer-Specific Survival of Patients with Major Salivary Gland Mucoepidermoid Carcinoma

Oncologic Safety of Close Margins in Patients With Low- to Intermediate-Grade Major Salivary Gland Carcinoma

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