Abstract
Despite being rare in incidence, malignant tumors of major salivary glands show diverse histological variation. There are limited data on major salivary gland tumor management and outcome from Pakistan. The objective of this study was to share our experience with management of malignant tumors of major salivary glands. Patients who received treatment at Shaukat Khanum Cancer Hospital and Research Center from July 2002 to June 2011 with an underlying diagnosis of a major salivary gland malignancy were included. Patient characteristics and treatment modalities were assessed. Local, regional and distant failures were determined. Disease free survival (DFS) and overall survival (OS) were calculated using Kaplan Meier curves and the Log rank test was used to determine statistical significance. Univariate and multivariate analyses were performed using Cox proportional hazard regression. The parotid gland was the primary site of origin in 104 (80%) patients. Mucoepidermoid carcinoma (43%) and adenoid cystic carcinoma (24%) were the most common histological types. Surgery followed by adjuvant radiation remained the mainstay treatment modality with 81 (62%) patients. Nineteen (15%) patients were treated with surgery alone and 30 (23%) patients with locally advanced surgically inoperable tumors received radiation only. Forty one (32%) patients failed the treatment (local 12, regional 11, locoregional 5, distant 13). The expected 5 year DFS and OS were 65% and 74% respectively. On multivariate analysis, grade was the only independent predictor of DFS and nodal involvement was the only independent predictor of overall survival. Employing existing standards of treatment, comparable survival can be achieved in Pakistani population with major salivary gland malignancies as elsehwere in the world.
Highlights
Malignant tumors of major salivary glands are rare and represent only 3%-6% of all head and neck (Pinkston and Cole, 1999) cancers (Spiro, 1986)
Surgery followed by adjuvant radiation remained the mainstay treatment modality with 81 (62%) patients
Nineteen (15%) patients were treated with surgery alone and 30 (23%) patients with locally advanced surgically inoperable tumors received radiation only
Summary
Malignant tumors of major salivary glands are rare and represent only 3%-6% of all head and neck (Pinkston and Cole, 1999) cancers (Spiro, 1986). Mucoepidermoid carcinoma (MECa) is the most common malignant tumor of parotid gland, whereas adenoid cystic carcinoma (ACCa) represents the most frequent histological type of submandibular and minor salivary gland tumor (Spiro and Dubner, 1990). Surgery remains the primary treatment modality in management of malignant tumors of major salivary gland. In the past, these tumors were considered radiation resistant and tumor bulk was thought to be responsible for this under achievement (Spiro et al, 1975; Terhaard et al, 2005). The objective of this study was to report clinical profile, treatment modalities and survival in patients with malignant tumors of major salivary gland in Pakistan. Conclusions: Employing existing standards of treatment, comparable survival can be achieved in Pakistani population with major salivary gland malignancies as elsehwere in the world
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