Survival Outcomes and Prognostic Factors in Salivary Gland Cancers Treated by Surgery and Adjuvant Radiotherapy

Aim: To evaluate the variables affecting prognostic factors in patients with salivary gland cancer who have received surgery followed by radiotherapy(RT).Materials and Methods: Fifty-three patients with major and minor salivary gland cancer were treated with curative surgery and postoperativeRT between 1993 and 2011. We evaluated patients with regard to overall survival, locoregional recurrence-free survival, disease free survival, anddistant metastasis-free survival.Results: The median follow-up period was 40 (8-174) months. The rates of local control, distant metastasis-free, disease-free survival and overallsurvival after 10 years were 65%, 57,7%, 38,8%, and 48,2%, respectively. In univariate analysis, histological subtype, histologic grade, extraglandularextension and delivered dose of RT were found to be as prognostic factors affecting locoregional recurrence-free survival; gender, histologicalsubtype, extraglandular extension influenced disease-free survival; overall survival was only affected by age. In multivariate analysis, locoregionalrecurrence-free survival was affected by histologic grade and dose of RT (60 Gy< better prognosis); distant metastasis-free survival was affectedby histological subtype; disease-free survival was affected by histological subtype, histologic grade, and lymph node status; overall survival wasaffected by lymph node status, extraglandular extension, and dose of RT (60 Gy< better prognosis).Conclusion: Several prognostic factors affecting local control, distant metastases, and overall survival were found. Postoperative RT is an effectivetreatment modality that increases local control and overall survival in patients with Salivary Gland Carcinoma at doses over 60 Gy.

Cerrahi Sonrası Adjuvan Radyoterapi Gören Tükürük Bezi Tümörü Tanılı Hastalarda Prognostik Faktörlerin Değerlendirilmesi ve Sağkalım Sonuçları

Amaç: Postoperatif radyoterapi (RT) almış tükürük bezi tümörü tanılı hastalarda prognostik faktörleri etkileyen değişkenleri değerlendirmek amaçlandı. Gereç ve Yöntem: 1993-2011 yılları arasında küratif cerrahi ve postoperatif RT ile tedavi edilen majör ve minör tükürük bezi kanserli elli üç hasta çalışmaya dahil edildi. Hastalar; genel sağkalım, lokorejyonel rekürrenssiz sağkalım, hastalıksız sağkalım ve uzak metastazsız sağkalım açısından değerlendirildi. Bulgular: Medyan takip süresi 40 (8-174) aydı. On yıl sonra lokal kontrol, uzak metastazsız, hastalıksız sağkalım ve genel sağkalım oranları sırasıyla %65, %57,7, %38,8 ve %48,2 idi. Tek değişkenli analizde, histolojik alt tip, histolojik grade, ekstraglandüler yayılım ve RT dozu lokorejyonel rekürrenssiz sağkalımı etkileyen prognostik faktörler olarak bulundu. Cinsiyet, histolojik alt tip, ekstraglandüler yayılım hastalıksız sağkalımı etkileyen faktörler olarak bulunurken, genel sağkalım sadece yaştan etkilendi. Çok değişkenli analizde, lokorejyonel rekürrenssiz sağkalım histolojik grade ve RT dozundan (>60 Gy, daha iyi prognoz); uzak metastazsız sağkalım, histolojik alt tipten; hastalıksız sağkalım, histolojik alt tip, histolojik grade, lenf nodu durumundan; genel sağkalım, lenf nodu durumu, ekstraglandüler yayılma ve RT dozundan (>60 Gy, daha iyi prognoz) etkilenmiştir. Sonuç: Lokal kontrolü, uzak metastaz gelişimini ve genel sağkalımı etkileyen çeşitli prognostik faktörler bulundu. Postoperatif RT, 60 Gy’nin üzerindeki dozlarda tükürük bezi karsinomu olan hastalarda lokal kontrolü ve genel sağkalımı artıran etkili bir tedavi yöntemidir.

PDF

___

1. Speight PM, Barrett AW. Salivary gland tumours. Oral Dis. 2002;8:229-40.

2. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al. SEER Cancer Statistics Review, 1975-2003. Available from: https://seer.cancer. gov/archive/csr/1975_2003/

3. Wahlberg P, Anderson H, Biörklund A, Möller T, Perfekt R. Carcinoma of the parotid and submandibular glands--a study of survival in 2465 patients. Oral Oncol. 2002;38:706-13.

4. Seethala RR, Stenman G. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Salivary Gland. Head Neck Pathol. 2017;11:55-67.

5. Westergaard-Nielsen M, Godballe C, Eriksen JG, Larsen SR, Kiss K, Agander T, et al. Salivary gland carcinoma in Denmark: a national update and followup on incidence, histology, and outcome. Eur Arch Otorhinolaryngol. 2021;278:1179-88.

6. Kordzińska-Cisek I, Grzybowska-Szatkowska L.Salivary gland cancer— epidemiology. Nowotwory. Journal of Oncology. 2018;68:22-7.

7. Ito FA, Ito K, Vargas PA, de Almeida OP, Lopes MA. Salivary gland tumors in a Brazilian population: a retrospective study of 496 cases. Int J Oral Maxillofac Surg. 2005;34:533-6.

8. Spiro IJ, Wang CC, Montgomery WW. Carcinoma of the parotid gland. Analysis of treatment results and patterns of failure after combined surgery and radiation therapy. Cancer. 1993;71:2699-705.

9. Cheraghlou S, Kuo P, Mehra S, Agogo GO, Bhatia A, Husain ZA, et al. Adjuvant therapy in major salivary gland cancers: Analysis of 8580 patients in the National Cancer Database. Head Neck. 2018;40:1343-55.

10. Parikh AS, Khawaja A, Puram SV, Srikanth P, Tjoa T, Lee H, et al. Outcomes and prognostic factors in parotid gland malignancies: A 10-year single center experience. Laryngoscope Investig Otolaryngol. 2019;4:632-9.

11. Frankenthaler RA, Luna MA, Lee SS, Ang KK, Byers RM, Guillamondegui OM, Wolf P, Goepfert H. Prognostic variables in parotid gland cancer. Arch Otolaryngol Head Neck Surg. 1991;117:1251-6.

12. Armstrong JG, Harrison LB, Spiro RH, Fass DE, Strong EW, Fuks ZY. Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy. Arch Otolaryngol Head Neck Surg. 1990;116:290-3.

13. Jones AS, Beasley NJ, Houghton DJ, Helliwell TR, Husband DJ. Tumours of the minor salivary glands. Clin Otolaryngol Allied Sci. 1998;23:27-33.

14. Renehan A, Gleave EN, Hancock BD, Smith P, McGurk M. Long-term follow-up of over 1000 patients with salivary gland tumours treated in a single centre. Br J Surg. 1996;83:1750-4.

15. Therkildsen MH, Christensen M, Andersen LJ, Schiødt T, Hansen HS. Salivary gland carcinomas--prognostic factors. Acta Oncol. 1998;37:701-13.

16. Spiro RH, Armstrong J, Harrison L, Geller NL, Lin SY, Strong EW. Carcinoma of major salivary glands. Recent trends. Arch Otolaryngol Head Neck Surg. 1989;115:316-21.

17. Lombardi D, Tomasoni M, Paderno A, Mattavelli D, Ferrari M, Battocchio S, et al. The impact of nodal status in major salivary gland carcinoma: A multicenter experience and proposal of a novel N-classification. Oral Oncol. 2021;112:105076.

18. Goel AN, Badran KW, Braun APG, Garrett AM, Long JL. Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients. Otolaryngol Head Neck Surg. 2018;158:287-94.

19. Hay AJ, Migliacci J, Karassawa Zanoni D, McGill M, Patel S, et al. Minor salivary gland tumors of the head and neck-Memorial Sloan Kettering experience: Incidence and outcomes by site and histological type. Cancer. 2019;125:3354-66.

20. Baddour HM Jr, Fedewa SA, Chen AY. Five- and 10-Year Cause-Specific Survival Rates in Carcinoma of the Minor Salivary Gland. JAMA Otolaryngol Head Neck Surg. 2016;142:67-73.

21. He S, Li P, Zhong Q, Hou L, Yu Z, Huang Z, et al. Clinicopathologic and prognostic factors in adenoid cystic carcinoma of head and neck minor salivary glands: A clinical analysis of 130 cases. Am J Otolaryngol. 2017;38:157-62.

22. Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Loftus-Coll BM, Keus RB, et al. The development of a prognostic score for patients with parotid carcinoma. Cancer. 1999;85:2057-67.

23. Honda K, Tanaka S, Shinohara S, Asato R, Tamaki H, Maetani T, et al. Survival in patients with parotid gland carcinoma - Results of a multicenter study. Am J Otolaryngol. 2018;39:65-70.

24. Nakano T, Yasumatsu R, Kogo R, Hashimoto K, Asai K, Ohga S, et al. Parotid gland carcinoma: 32 years’ experience from a single institute. J Laryngol Otol. 2019;133:604-9.

25. Kane WJ, McCaffrey TV, Olsen KD, Lewis JE. Primary parotid malignancies. A clinical and pathologic review. Arch Otolaryngol Head Neck Surg. 1991;117:307-15.

26. Garden AS, el-Naggar AK, Morrison WH, Callender DL, Ang KK, Peters LJ. Postoperative radiotherapy for malignant tumors of the parotid gland. Int J Radiat Oncol Biol Phys. 1997;37:79-85.

27. Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg. 1986;8:177-84.

28. Fu KK, Leibel SA, Levine ML, Friedlander LM, Boles R, Phillips TL. Carcinoma of the major and minor salivary glands: analysis of treatment results and sites and causes of failures. Cancer. 1977;40:2882-90.

29. Fitzpatrick PJ, Theriault C. Malignant salivary gland tumors. Int J Radiat Oncol Biol Phys. 1986;12:1743-7.

30. Borthne A, Kjellevold K, Kaalhus O, Vermund H. Salivary gland malignant neoplasms: treatment and prognosis. Int J Radiat Oncol Biol Phys. 1986;12:747-754.

31. Ostman J, Anneroth G, Gustafsson H, Tavelin B. Malignant salivary gland tumours in Sweden 1960-1989--an epidemiological study. Oral Oncol. 1997;33:169-76.

32. Weber RS, Byers RM, Petit B, Wolf P, Ang K, Luna M. Submandibular gland tumors. Adverse histologic factors and therapeutic implications. Arch Otolaryngol Head Neck Surg. 1990;116:1055-60.

33. McGuirt WF. Management of occult metastatic disease from salivary gland neoplasms. Arch Otolaryngol Head Neck Surg. 1989;115:322-5.

34. Terhaard CH, Lubsen H, Van der Tweel I, Hilgers FJ, Eijkenboom WM, Marres HA, et al. Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head Neck. 2004;26:681-92.

35. Hoffman HT, Karnell LH, Robinson RA, Pinkston JA, Menck HR. National Cancer Data Base report on cancer of the head and neck: acinic cell carcinoma. Head Neck. 1999;21:297-309.

36. Brandwein MS, Ivanov K, Wallace DI, Hille JJ, Wang B, Fahmy A, et al. Mucoepidermoid carcinoma: a clinicopathologic study of 80 patients with special reference to histological grading. Am J Surg Pathol. 2001;25:835- 45.

37. Terhaard CH, Lubsen H, Rasch CR, Levendag PC, Kaanders HH, Tjho-Heslinga RE, et al. The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys. 2005;61:103-11.