Abstract
PurposeSalivary Gland cancer (SGC) is a rare and heterogenous group of tumors. Standard therapeutic options achieve high local but poor distant control rates, especially in high-grade SGC. The aim of this monocentric study was to evaluate patterns of recurrence and its treatment options (local ablative vs. systemic) in a homogenously treated patient population with high-grade SGC after surgery and radio(chemo)therapy.MethodsMonocentric, retrospective study of patients with newly diagnosed high-grade salivary gland cancer. We retrospectively reviewed clinical reports from 69 patients with high-grade salivary gland cancer in a single-center audit. Survival rates were calculated using the Kaplan–Meier method and prognostic variables were analyzed (univariate analysis: log-rank test; multivariate analysis: Cox regression analysis).ResultsThe median time of follow-up was 31 months. After 5 years, the cumulative overall survival was 65.2%, cumulative incidence of local recurrence was 7.2%, whereas the cumulative incidence of distant metastases was 43.5% after 5 years. 30 of 69 patients developed distant metastases during the time of follow-up, especially patients with adenoid cystic carcinoma, salivary duct carcinoma, adenocarcinoma NOS and acinic cell carcinoma with high-grade transformation. The most common type of therapy therefore was chemotherapy (50%). 85.7% of patients with local ablative therapy of distant metastases show disease progression during follow-up afterwards.ConclusionWith surgery and radio-chemotherapy, a high rate of loco-regional control is reached, but over 40% of patients develop distant metastases in the further follow-up which usually present a diffuse pattern involving in a diffuse metastases. Therefore, in the future, intensified interdisciplinary combination therapies even in the first-line treatment in certain subtypes of high-grade SGC should be investigated.
Highlights
Salivary gland cancer (SGC) is a rare disease (0.6–1.4 per 100,000 [1]) including various histological tumor subtypes [2]
Some studies suggest that patients with metastatic SGC, especially patients with adenoid cystic carcinomas (AdCC), benefit from local therapeutic options [12, 13]
Investigating only locally advanced high-grade tumours after postoperative radio(chemo)therapy on multivariate analysis, we found that patients with adenoid cystic carcinoma (AdCC) of the salivary glands had a significant lower Disease‐free survival (DFS) and a higher incidence of distant metastases
Summary
Salivary gland cancer (SGC) is a rare disease (0.6–1.4 per 100,000 [1]) including various histological tumor subtypes (more than 20 according to the WHO classification of head and neck cancers of 2017) [2]. The established standard therapy is surgery and, in case of locally advanced disease, postoperative radio(chemo)therapy [3,4,5,6,7] In this way, local control rates of about 90% are achieved, but a large percentage of patients develop distant metastases resulting in a decrease in overall and disease-specific survival [8]. Some studies suggest that patients with metastatic SGC, especially patients with adenoid cystic carcinomas (AdCC), benefit from local therapeutic options [12, 13] In this retrospective study, a homogenously treated patient population with high-grade SGC who had undergone surgery and postoperative radio(chemo)therapy is evaluated regarding incidence and location of distant metastases and their respective treatment options (local ablative vs systemic) A homogenously treated patient population with high-grade SGC who had undergone surgery and postoperative radio(chemo)therapy is evaluated regarding incidence and location of distant metastases and their respective treatment options (local ablative vs. systemic)
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