Abstract
PurposeThis study analyzed survival and toxicity after (chemo)radiotherapy for primary salivary gland cancer patients aged ≥ 65 years and compared these results with younger patients using a matched-pair analysis.MethodsTwenty-nine elderly patients with primary salivary gland carcinomas treated with (chemo)radiotherapy from 2008 to 2020 at University of Freiburg Medical Center were analyzed for oncological outcomes and therapy-associated toxicities. Local/locoregional control (LRC), progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method, and the influence of clinical parameters on patient outcomes was assessed. A matched-pair analysis was performed after matching with patients < 65 years.ResultsNine patients (31.0%) received definitive (chemo)radiotherapy, and 20 patients (69.0%) were treated in the adjuvant setting. 2-year LRC, PFS and OS ranged at 82.4%, 53.7% and 71.8%, respectively. Smoking (HR 3.980, p = 0.020), reduced performance status (HR 3.735, p = 0.016) and higher comorbidity burden (HR 4.601, p = 0.005) correlated with inferior OS. Using a matched-pair analysis with younger patients, elderly patients exhibited a trend towards reduced OS (HR 3.015, p = 0.065), but not PFS (HR 1.474, p = 0.371) or LRC (HR 1.324, p = 0.633). Acute and chronic grade 3 toxicities occurred in 31.0% and 12.5% of elderly patients, respectively, and the matched-pair analysis revealed no significant differences between age groups regarding treatment-related toxicities.ConclusionTreatment-related toxicities as well as LRC and PFS were comparable for salivary gland cancer patients undergoing radiotherapy. Therefore, concerns for more pronounced toxicities or reduced local/locoregional response rates should not guide treatment decisions in affected elderly patients.
Highlights
Primary malignant salivary gland tumors are rare with an annual incidence of about 1 in 100,000 people, accounting for about 5% of all head-and-neck cancer cases [1, 2]
For headand-neck squamous cell carcinomas (HNSCC), it has been demonstrated that the benefit of simultaneous chemotherapy administration during radiotherapy decreases with age, but similar data are lacking for elderly patients with malignant salivary gland tumors [12,13,14]
Our results derived from a retrospective single-center matched-pair analysis show that elderly salivary gland patients who were treated withradiotherapy exhibited respectable locoregional control (LRC) rates, but relatively poor survival rates, probably reflecting the advanced age of our treatment cohort
Summary
Primary malignant salivary gland tumors are rare with an annual incidence of about 1 in 100,000 people, accounting for about 5% of all head-and-neck cancer cases [1, 2]. For headand-neck squamous cell carcinomas (HNSCC), it has been demonstrated that the benefit of simultaneous chemotherapy administration during radiotherapy decreases with age, but similar data are lacking for elderly patients with malignant salivary gland tumors [12,13,14]. As the various salivary gland cancer histologies exhibit distinct age peaks, the prognosis of elderly salivary gland cancer patients may be different to younger patients; for instance, the incidence of low-grade mucoepidermoid carcinomas, which is known to have a relatively good prognosis, is higher in younger than in elderly patients [1, 7, 9]. Complete surgical resection alone is recommended for early-stage tumors, while adjuvant radiotherapy is often applied after surgery for locally advanced tumors, nodal metastases or in case of other risk factors for recurrence such as adenoid cystic carcinoma histologies, high-grade tumors (G3/ G4), close or positive resection margins, perineural or lymphovascular invasion. We present the first matched-pair analysis between elderly and younger salivary gland cancer patients undergoing (chemo)therapy, aiming to examine the role of patient age regarding oncological outcomes and treatment-related toxicities
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