Abstract
BackgroundTo report the outcomes of patients with locoregionally advanced and high- risk salivary gland malignancies treated with surgery followed by adjuvant chemoradiotherapy.MethodsFrom 09/1991 - 06/2007, 24 high-risk salivary gland cancer patients were treated with surgery, followed by adjuvant chemoradiotherapy for high-risk pathologic features including, perineural involvement, nodal involvement, positive margins, or T3/T4 tumors. Chemoradiotherapy was delivered for 4-6 alternating week cycles: the most common regimen, TFHX, consisted of 5 days paclitaxel (100 mg/m2 on d1), infusional 5-fluorouracil (600 mg/m2/d × 5d), hydroxyurea (500 mg PO BID), and 1.5 Gy twice daily irradiation followed by a 9-day break without treatment.ResultsMedian follow-up was 42 months. The parotid gland was more frequently involved (n = 17) than minor (n = 4) or submandibular (n = 3) glands. The median radiation dose was 65 Gy (range 55-68 Gy). Acute treatment related toxicity included 46% grade 3 mucositis and 33% grade 3 hematologic toxicity. Six patients required feeding tubes during treatment. One patient progressed locally, 8 patients progressed distantly, and none progressed regionally. Five-year locoregional progression free survival was 96%. The 3 and 5 year overall survival was 79% and 59%, respectively. Long-term complications included persistent xerostomia (n = 5), esophageal stricture requiring dilatation (n = 1), and tempromandibular joint syndrome (n = 1).ConclusionsSurgical resection followed by adjuvant chemoradiotherapy results in promising locoregional control for high-risk salivary malignancy patients.
Highlights
To report the outcomes of patients with locoregionally advanced and high- risk salivary gland malignancies treated with surgery followed by adjuvant chemoradiotherapy
Adjuvant radiotherapy in patients with high-grade tumors or high- risk features, improves locoregional control in select patients undergoing surgical resection compared to surgical resection alone [1,3,4,5,6,7,8,9]
Concurrent chemoradiotherapy has been established as the standard of care for many patients either definitively or adjuvantly with locally advanced head and neck cancer
Summary
To report the outcomes of patients with locoregionally advanced and high- risk salivary gland malignancies treated with surgery followed by adjuvant chemoradiotherapy. Salivary gland cancers comprise 3-6% of all head and neck malignancies [1,2]. They are commonly grouped together, these cancers are histologically diverse with varying natural histories. Surgery is the established initial treatment for salivary gland malignancies. Adjuvant radiotherapy in patients with high-grade tumors or high- risk features, improves locoregional control in select patients undergoing surgical resection compared to surgical resection alone [1,3,4,5,6,7,8,9]. Chemotherapy is not routinely used outside of the palliative or recurrent treated adjuvantly with concurrent FHX based chemoradiotherapy for salivary glands carcinomas
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