Outcomes after primary or adjuvant radiotherapy for salivary gland carcinoma

Abstract

Background: We report long-term outcomes of patients treated with primary radiotherapy (RT) or surgery and adjuvant RT for salivary gland malignancies. Materials and methods: From 1964 to 2012, 291 patients received primary RT (n ¼ 67) or RT combined with surgery (n ¼ 224). Results: The 5-, 10-, and 15-year local control, local-regional control, distant metastasis-free survival, cause-specific survival and overall survival rates were 82%, 77% and 73%; 77%, 72% and 67%; 74%, 70% and 70%; 70%, 59% and 54%; and 63%, 47% and 38%, respectively. Per multivariate analysis, combined surgery and RT and T stage impacted local control; overall stage and combined surgery and RT impacted local-regional control; overall stage impacted distant metastasis-free survival; and overall stage, node positivity, clinical nerve invasion, and surgery and RT impacted cause-specific and overall survival. Five percent of patients experienced grade 3 or worse toxicity. Conclusion: Combined surgery and RT improves local control, local-regional control, and cause-specific survival compared with primary RT for salivary tumors.

Treatment Outcome of a Combined Dose-Escalated Treatment Regime With Helical TomoTherapy® and Active Raster-Scanning Carbon Ion Boost for Adenocarcinomas of the Head and Neck

“…Thus, Mendenhall et al reported severe late side effects in overall 13 of 224 SGC patients (6%), consisting of osteoradionecrosis ( n = 4, 2%), unilateral vision loss ( n = 6, 3%), fistula ( n = 1, 0.4%), submental abscess ( n = 1, 0.4%), and secondary malignancy ( n = 1, 0.4%) who were treated with definite or postoperative photon beam RT (51). In accordance to Mendenhall's results, Holtzman et al showed osteoradionecrosis in 5% ( n = 14/291) and vision/hearing loss in 6% ( n = 17/291) of their patients treated with the same method (52). For bimodal RT including IMRT and CIRT, Jensen et al could identify hearing impairment in 13% ( n = 5/40) of the patients with non-ACC SGCs (46).…”

“…More conformal RT techniques, i.e., IMRT, the development of high linear-energy transfer RT, i.e., neutron RT or carbon ion RT, and improved imaging procedures, i.e., positron emission tomography (PET-CT), have led to decreased toxicity rates compared with conventional or 3-dimensional RT in head and neck cancer (27, 28). Nevertheless, certain late adverse effects, i.e., brain injury, osteoradionecrosis, hearing impairment/hearing loss, visual impairment/visual loss, nerve palsy and fistula, are still diagnosed to a large extent after RT and can occur years after the completion of the treatment (39, 44, 46, 51, 52). Thus, Mendenhall et al reported severe late side effects in overall 13 of 224 SGC patients (6%), consisting of osteoradionecrosis ( n = 4, 2%), unilateral vision loss ( n = 6, 3%), fistula ( n = 1, 0.4%), submental abscess ( n = 1, 0.4%), and secondary malignancy ( n = 1, 0.4%) who were treated with definite or postoperative photon beam RT (51).…”

An update on head and neck cancer: new entities and their histopathology, molecular background, treatment, and outcome

“…At present, no molecular features of the salivary gland tumors can be used to direct the dose and volume of radiation. Primary RT has never been evaluated against primary surgery in randomized clinical trials, but retrospective data from small studies suggest that acceptable results can be obtained in situations where the patient is not eligible for or refuses surgery . For parotid tumors, a radiation field including level 1b, II, and III is recommended while the entire level I‐III region is included for other sites.…”

“…For parotid tumors, a radiation field including level 1b, II, and III is recommended while the entire level I‐III region is included for other sites. Despite the lack of randomized studies, adjuvant RT has been shown to improve local control rates, especially in T3 and T4 tumors, close or involved resection margins, high‐grade histology, perineural invasion, or nodal disease . Preliminary studies have shown a benefit of carbon ion therapy in ACC and MEC but definitive evidence is currently lacking .…”

Cysteinyl Leukotrienes as Potential Pharmacological Targets for Cerebral Diseases

“…It is pathologically characterized by extracellular deposit of β -amyloid (A β ) plaques and intracellular neurofibrillary tangles (NFTs) of tau protein [112, 113]. Altered inflammatory reactions and dysregulation of inflammatory cytokines as well as immune cell (i.e., microglia and astrocytes) activation are also strongly associated with AD pathology and cognitive dysfunction [114, 115].…”