A clinical analysis of 37 cases with lymphoepithelial carcinoma of the major salivary gland treated by surgical resection and postoperative radiotherapy: a single institution study

Abstract

The present study was undertaken to evaluate the diagnostic approaches, treatment results and failure patterns of lymphoepithelial carcinoma of the major salivary gland (LECSG). Patients were treated by definitive surgical resection and postoperative radiotherapy in an attempt to identify the proper strategies for the management of this disease. Patients with a histological diagnosis of primary lymphoepithelial carcinoma in the major salivary gland that was treated at our institution between January 2005 and December 2011 were comprehensively analyzed. An en bloc radical excision, which generally removes the salivary gland with level II and Ib lymph nodes, followed by postoperative radiotherapy was the standard treatment for this group of patients. Radical neck dissection was only performed in patients with metastatic lymphadenopathy. Postoperative irradiation was delivered to the tumor bed and involved nodes at a dose of 60 Gy and to the ipsilateral cervical lymph nodes at a dose of 56 Gy. Clinical and pathological factors correlated with locoregional control (LRC), progression-free survival (PFS) and overall survival (OS) were analyzed using the log-rank test and a Cox proportional hazards model. A total of 37 patients with a median age of 45 years were enrolled in this study. The study population consisted of 21 males and 16 females. There were seven patients with stage I disease, 10 patients with stage II disease, nine patients with stage III disease and 11 patients with stage IV disease. With a median follow-up of 39 months (range 12-90 months), the 3-year LRC, PFS and OS were 94.3, 91.6, and 92.9%, respectively. Only two patients died of local-regional recurrences and distant metastases. No statistically significant prognostic predictors of LRC, PFS and OS were found. The presence of positive cervical lymph nodes showed a trend toward poorer outcome. Surgical resection with postoperative radiotherapy is a reasonable and proper treatment approach in the definitive management of LECSG and results in a favorable prognosis for a significant proportion of patients. No clinicopathological or therapeutic features were found to be suitable predictive factors for prognosis; thus, disease progression should be carefully monitored, especially for those patients with cervical node involvement.