| Purpose:To report our experience in treating patients with major salivary gland malignancies who had undergone surgical resection (primary tumors resection ± neck dissection) followed by postoperative adjuvant radiotherapy (PORT) with or without chemotherapy.Methods and materials:Between 2005 and 2011,205 patients with major salivary gland cancer treated at Department of Radiation Oncology, Cancer Hospital, Fudan University with surgical resection and postoperative radiotherapy (PORT) ± chemotherapy were analyzed. In the postoperative setting, the primary tumor and involved lymph node bed constitute the planning target volume and are generally treated to 60Gy in 30 fractions (R 56-66Gy). Ipsilateral cervical lymph nodes are routinely targeted when involved and elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. For patients without clinical or pathologic lymph node involvement, elective nodal irradiation to a dose of 50-56Gy is usually reserved for patients with adverse prognostic factors. Chemotherapy was administered at the discretion of the treating medical oncologist based on tumor histology and high-risk features. The primary endpoints were progression-free survival(PFS), overall survival (OS) and adverse prognostic factors. Univariate and multivariable regression analyses were performed to identify factors associated with improved survival.Results:The median follow-up for all patients was 51 months (R 5-109 months). The tumor was located in the parotid gland in 168 cases, submandibular gland in 36 cases and sublingual gland in one case. The histologic types included lymphoepithelial carcinoma in 49, mucoepidermoid carcinoma in 38, adenoid cystic carcinoma in 33, salivary duct carcinoma in 22, adenocarcinoma NOS in 20, acinic cell carcinoma in 16 and other in 27. Surgery and radiotherapy were applied to all patients, with a median dose of 60Gy. Median delay between surgery and radiotherapy was 5 weeks.29 patients undergone chemotherapy in the disease course and more adverse prognostic factors prevailed in the chemotherapy group, including stage T3-T4 disease, nodal positivity and positive margins and perineural invasion. The most common chemotherapy regimen was platinum-based regimen.39 failure events were reported:33 distant metastases and 13 local-regional recurrent.7 distant metastases and local-regional recurrent simultaneously. PFS and OS at 3,5 years were 82.1%, 79.8% and 85.7%,85.1%, respectively. On multivariate analysis, LN involvement and presence of perineural/neural invasion correlated significantly with OS. Age, sex, LN involvement and presence of perineural/neural invasion correlated with PFS.Conclusions:Surgical resection and postoperative radiotherapy for major salivary malignancies result in promising locoregional control and overall survival. Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects.Patients with male sex, old age, LN involvement and presence of perineural/neural invasion had a bad prognosis. However, in view of the pattern of failures observed in this study, mostly occurred in the first 2 years after treatment, distance metastasis is the main cause of treatment failure. The role of adjuvant systemic or targeted therapy in patients at high risk of DM should be investigated in prospective trials.Purpose:The present study was undertaken to evaluate the diagnostic approaches, treatment results and failure patterns of lymphoepithelial carcinoma of the major salivary glands (LECSG) who were treated by comprehensive therapy modalities in an attempt to identify the proper strategies for the management of this disease.Material and Methods:Patients with a histologic diagnosis of primary lymphoepithelial carcinoma in the major salivary gland that were treated at our institution between January 2005 and December 2011 were comprehensively analyzed. All patients undergone surgery and adjuvant radiotherapy, some patients received chemotherapy simultaneously. An en bloc radical excision, which generally removes the primary gland with level II and I b lymph nodes, followed by adjuvant radiotherapy was the standard treatment for this group of patients. Radical neck dissection was only performed in patients with metastatic lymphadenopathy. Postoperative irradiation was delivered to the surgical bed of the tumor and involved nodes at a dose of 60Gy and to the ipsilateral cervical lymph nodes at a dose of 56Gy. Clinical and pathological factors correlated with progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier.Results:A total of 49 patients with a median age of 44 years were enrolled in this study. The study population consisted of 28 males and 21 females. There were twenty-one patients with stage Ⅰ-Ⅱ disease, and 28 patients with stage Ⅲ-Ⅳ disease. With a median follow-up of 46 months (range,12 to 109 months), the 3-year、5-year estimated progression-free survival (PFS) and overall survival (OS) were 89.8%、 82.0% and 91.3%、91.3%, respectively. During follow-up, only four patients died.Two of them died of local-regional recurrence and distant metastases. The other two died of local-regional recurrence. Univariate and multiple factor analysis showed that the primary tumor site was an independent prognostic factor for PFS, patients with older age or with lymph node metastasis tended to have a poor prognosis. Even add chemotherapy into patients with late stage, the curative effect is still poor.Conclusions:Surgical resection with adjuvant radiotherapy is a reasonable and proper treatment approach in the definitive management of LECSG and results in a favorable prognosis for a significant proportion of patients. Patients achieved good survival in our study. |
PDF Full Text Request