High-grade salivary gland cancer: is surgery followed by radiotherapy an adequate treatment to reach tumor control? Results from a tertiary referral centre focussing on incidence and management of distant metastases

Language
en
Document Type
Article
Issue Date
2023-03-28
First published
2022-05-01
Issue Year
2022
Authors
Freitag, Viola
Lettmaier, Sebastian
Semrau, Sabine
Hecht, Markus
Mantsopoulos, Konstantinos
Müller, Sarina K.
Traxdorf, Maximillian
Iro, Heinrich
Agaimy, Abbas
Fietkau, Rainer
Editor
Publisher
Springer Berlin Heidelberg
Abstract

Purpose

Salivary 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.

Methods

Monocentric, 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).

Results

The 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.

Conclusion

With 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.

Journal Title
European Archives of Oto-Rhino-Laryngology
Volume
279
Issue
5
Citation

European Archives of Oto-Rhino-Laryngology 279.5 (2022): S. 2553–2563. https://link.springer.com/article/10.1007/s00405-021-07024-9