Elective Neck Management for High Grade Salivary Gland Carcinoma

Abstract

Purpose/Objective(s)The authors analyzed the outcomes of high-grade salivary gland patients treated with elective neck dissection and postoperative radiation therapy (RT) versus elective neck irradiation in conjunction with postoperative RT.Materials/MethodsBetween October 1964 and October 2009, 65 previously untreated clinically node-negative neck patients were treated with curative intent with elective neck dissection (END; n = 43), elective neck irradiation (ENI; n = 20), or no elective neck treatment (n = 2). All patients had high-grade salivary gland tumor histology (squamous cell histology was excluded). The median follow-up period was 5.2 years (range, 0.3-34 years).ResultsOccult metastases were found in 19 (44%) of the 43 patients in the END group. There were 4 recurrences (6%) in the END group and 0 recurrences in the ENI group. Neck control was 100% in the ENI, 90% in the END group, and 93% for all patients (p=0.177). Cause-specific survival was 95% in the ENI group, 84% in the END group, and 88% for all patients (p=0.9713). Nine patients experienced grade 3 or 4 toxicities. Four patients (6%) had grade 3 mucositis requiring feeding tube placement. Three patients (5%) had fistulas from surgery. Two patients (3%) had grade 4 osteonecrosis of the jaw requiring mandibulectomy.ConclusionsElective neck management indications include high-grade histology and T3/T4 primary. Elective neck irradiation provides excellent regional control. If postoperative RT is indicated preoperatively, then elective neck dissection is unnecessary. Purpose/Objective(s)The authors analyzed the outcomes of high-grade salivary gland patients treated with elective neck dissection and postoperative radiation therapy (RT) versus elective neck irradiation in conjunction with postoperative RT. The authors analyzed the outcomes of high-grade salivary gland patients treated with elective neck dissection and postoperative radiation therapy (RT) versus elective neck irradiation in conjunction with postoperative RT. Materials/MethodsBetween October 1964 and October 2009, 65 previously untreated clinically node-negative neck patients were treated with curative intent with elective neck dissection (END; n = 43), elective neck irradiation (ENI; n = 20), or no elective neck treatment (n = 2). All patients had high-grade salivary gland tumor histology (squamous cell histology was excluded). The median follow-up period was 5.2 years (range, 0.3-34 years). Between October 1964 and October 2009, 65 previously untreated clinically node-negative neck patients were treated with curative intent with elective neck dissection (END; n = 43), elective neck irradiation (ENI; n = 20), or no elective neck treatment (n = 2). All patients had high-grade salivary gland tumor histology (squamous cell histology was excluded). The median follow-up period was 5.2 years (range, 0.3-34 years). ResultsOccult metastases were found in 19 (44%) of the 43 patients in the END group. There were 4 recurrences (6%) in the END group and 0 recurrences in the ENI group. Neck control was 100% in the ENI, 90% in the END group, and 93% for all patients (p=0.177). Cause-specific survival was 95% in the ENI group, 84% in the END group, and 88% for all patients (p=0.9713). Nine patients experienced grade 3 or 4 toxicities. Four patients (6%) had grade 3 mucositis requiring feeding tube placement. Three patients (5%) had fistulas from surgery. Two patients (3%) had grade 4 osteonecrosis of the jaw requiring mandibulectomy. Occult metastases were found in 19 (44%) of the 43 patients in the END group. There were 4 recurrences (6%) in the END group and 0 recurrences in the ENI group. Neck control was 100% in the ENI, 90% in the END group, and 93% for all patients (p=0.177). Cause-specific survival was 95% in the ENI group, 84% in the END group, and 88% for all patients (p=0.9713). Nine patients experienced grade 3 or 4 toxicities. Four patients (6%) had grade 3 mucositis requiring feeding tube placement. Three patients (5%) had fistulas from surgery. Two patients (3%) had grade 4 osteonecrosis of the jaw requiring mandibulectomy. ConclusionsElective neck management indications include high-grade histology and T3/T4 primary. Elective neck irradiation provides excellent regional control. If postoperative RT is indicated preoperatively, then elective neck dissection is unnecessary. Elective neck management indications include high-grade histology and T3/T4 primary. Elective neck irradiation provides excellent regional control. If postoperative RT is indicated preoperatively, then elective neck dissection is unnecessary.