Salivary duct carcinoma: Treatment, outcomes, and patterns of failure

Johnston, Melissa P.; Huang, Shao Hui; Waldron, John; Atenafu, Eshetu G; Chan, Kelvin; Cummings, Bernard; Gilbert, Ralph W.; Goldstein, David P.; Gullane, Patrick; Irish, Jonathan C.; Perez-Ordonez, Bayardo; Weinreb, Ilan; Bayley, Andrew; Cho, John; Dawson, Laura A.; Hope, Andrew; Ringash, Jolie; Witterick, Ian J.; O’Sullivan, Brian; Kim, John

doi:10.1002/hed.24107

Cited by 90 publications

(136 citation statements)

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“…Kleinsasser et al (25). This type of cancer is considered to be among the most aggressive salivary gland carcinomas due to the high frequency of local recurrence, as well as associated cervical lymph node and distant metastases (2,(7)(8)(9)(10)(11)(12). The most common treatment for SDC is surgery, particularly extended radical resection and ipsilateral neck dissection, with postoperative radiotherapy (2,6,7).…”

Section: Case Reportmentioning

confidence: 99%

“…Between 2005 and 2015, SDC patients were frequently diagnosed at an advanced stage, as in 55-82% of the cases the disease had already spread to the cervical lymph nodes on first diagnosis. Furthermore, local and regional recurrence and distant metastasis following surgery and postoperative radiotherapy were observed in 11-48, 8-26 and 24-63% of the patients, respectively, with a 5-year survival rate of 42-55% (2,(7)(8)(9)(10)(11)(12).…”

Section: Case Reportmentioning

confidence: 99%

“…The majority of those patients received palliative therapy or supportive care, although some underwent salvage surgery and additional radiation therapy, alone or combined with chemotherapy. However, all the patients have since succumbed to the disease (9). The most frequent cause of death is distant metastasis, and 65% of patients with distant metastases succumb to the disease 5 months-10 years later (5,26,27).…”

Section: Sdc Was First Described In 1968 Bymentioning

confidence: 99%

“…Although local and regional recurrence are correlated with prognosis, targeting the metastatic potential of SDC is crucial for disease control (28). Sites of distant metastasis include the lungs, bones, liver, skin and brain, although in most cases metastases develop in the lungs and bones (9,28). Systemic chemotherapy should therefore be considered for the treatment of distant metastasis, although there have been no convincing reports regarding chemotherapy for SDC.…”

Section: Sdc Was First Described In 1968 Bymentioning

confidence: 99%

“…The overall 5-year survival rate associated with SDC is low (42-55%) (2,(7)(8)(9)(10)(11)(12). Recent studies have tested molecularly targeted therapies as novel treatment strategies for SDC.…”

Section: Introductionmentioning

confidence: 99%

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Salivary duct carcinoma treated with cetuximab-based targeted therapy: A case report

Kawahara

Hiraki

Yoshida

et al. 2017

Molecular and Clinical Oncology

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Abstract. Salivary duct carcinoma is a highly aggressive disease with a poor prognosis. Surgical resection is currently the only curative treatment, as there is no effective systemic therapy for this malignancy. Recently, trastuzumab has been shown to exhibit therapeutic efficacy in the treatment of salivary duct carcinoma; similarly, molecularly targeted agents, such as cetuximab, are expected to be useful for salivary duct carcinoma treatment. We herein describe the case of a 56-year-old man diagnosed with salivary duct carcinoma in the left submandibular region, with ipsilateral multiple metastases to the neck lymph nodes. Radical resection of the tumor and submandibular gland with neck dissection were performed. One month after radical surgery, computed tomography (CT) scans indicated metastasis in the lower lobe of the left lung. CT-guided transthoracic fine-needle aspiration biopsy revealed a single metastasis and lung metastasectomy was immediately performed. The tumor cells of the primary lesion and those of the lung metastasis were immunohistochemically positive for epidermal growth factor receptor. One month later, multiple right lung metastases appeared, and the patient was treated with cisplatin/5-fluorouracil (5-FU) chemotherapy plus cetuximab, achieving a complete radiographic response. However, multiple lung metastases developed during adjuvant weekly cetuximab monotherapy. Subsequently, treatment with S-1 and weekly cetuximab was initiated, and the multiple lung metastases have been maintained as stable disease for 5 months. To the best of our knowledge, this is the first report of cetuximab use for the treatment of salivary duct carcinoma. Although cisplatin/5-FU chemotherapy plus cetuximab was efficacious in treating the lung metastasis, cetuximab monotherapy was insufficient for controlling tumor growth.

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Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Sdc Was First Described In 1968 Bymentioning

confidence: 99%

Section: Sdc Was First Described In 1968 Bymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Salivary duct carcinoma treated with cetuximab-based targeted therapy: A case report

Kawahara

Hiraki

Yoshida

et al. 2017

Molecular and Clinical Oncology

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A 20-Year Review of 75 Cases of Salivary Duct Carcinoma

Gilbert

Sharma

Schmitt

et al. 2016

JAMA Otolaryngol Head Neck Surg

126

144

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IMPORTANCE Salivary duct carcinoma is a rare, aggressive malignancy of the salivary glands. Owing to its rare nature, clinical data are limited, and only a few clinical studies comprise more than 50 patients. OBJECTIVE To review the University of Pittsburgh Medical Center’s experience with salivary duct carcinoma over a 20-year period, focusing on demographics, presentation, treatment, and outcome. DESIGN, SETTING, AND PARTICIPANTS This investigation was a retrospective cohort study in a multihospital institution with tertiary referral. A pathology database was reviewed for all cases of histopathologically diagnosed salivary duct carcinoma from January 1, 1995, to October 20, 2014. Patients who were referrals for pathology review only and were never seen at the institution were excluded. In total, 75 study patients were identified. The electronic medical record was reviewed for details regarding demographics, presentation, treatment, and outcome, including overall survival (OS) and disease-free survival (DFS). This study was supplemented with a review of the institution’s Head and Neck Oncology Database for further clinical details. MAIN OUTCOMES AND MEASURES Primary outcome measures consisted of OS and DFS. RESULTS The study sample comprised 75 participants with a mean age at diagnosis of 66.0 years (age range, 33–93 years), and 29% (n = 22) were female. Most primary tumors were from the parotid gland (83%), with the next most frequent site being the submandibular gland (12%). Overall, 41% of the cases were carcinoma ex pleomorphic adenoma. Rates of other histologic features included the following: perineural invasion (69%), extracapsular spread (58%), ERBB2 (formerly HER2) positivity (31%) (62% of those who were tested), and vascular invasion (61%). The median OS was 3.1 years, and the median DFS was 2.7 years. Univariate Kaplan-Meier survival analyses demonstrated that facial nerve sacrifice and extracapsular spread were associated with lower OS (2.38 vs 5.11 years and 2.29 vs 6.56 years, respectively) and DFS (2.4 vs 3.88 years and 1.44 vs 4.5 years, respectively). Although underpowered, multivariable analysis demonstrated significantly worse OS in patients with N2 and N3 disease (hazard ratio [HR] 8.42, 95% CI, 1.84–38.5) but did not show significantly worse DFS or OS for facial nerve sacrifice or extracapsular spread. There was no association between ERBB2 positivity and survival and no difference in survival between patients receiving radiation therapy vs radiation therapy plus chemotherapy. No patients had recurrence or distant metastasis after 5 disease-free years. CONCLUSIONS AND RELEVANCE Salivary duct carcinoma is an aggressive disease. A large number of cases in this review were carcinoma ex pleomorphic adenoma and had classic negative prognostic indicators, such as perineural invasion, vascular invasion, and extracapsular spread. ERBB2 positivity was not associated with any difference in survival. Facial nerve involvement appears to indicate worse prognosis, as does nodal stage higher th...

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