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Our results of postoperative radiation therapy in patients with salivary gland cancer

Year 2014, Volume: 24 Issue: 6, 316 - 323, 25.12.2014

Abstract

Objectives: This study aims to evaluate our single center experience in patients with a salivary gland tumor receiving postoperative radiation therapy RT . Patients and Methods: Between January 1996 and December 2011, the records of 34 salivary gland tumor patients who were operated and referred to our clinic for adjuvant RT were retrospectively analyzed. Radiation therapy was applied to the primary tumor and lymphatics at a median dose of 60 Gy 54 to 60 Gy with 1.8-2 Gy/fraction. Results: The median follow-up was 38 months range, 3 to 204 months . The most common site of involvement was the parotid gland in 21 patients 62% , followed by the submandibular gland in 11 patients %24 and minor salivary gland in two patients 9% . Five-year overall survival OS was 49% range, 3 to 206 months and disease free survival DFS was 61% range, 1 to 173 months . Six patients had local or regional recurrences 18% , while 13 patients 38% had distant metastasis. A tumor size larger than 4 cm, over six weeks referral time to RT, and existence of metastatic lymph node were found to be poor prognostic factors for OS p=0.023, p=0.039, respectively , and DFS p=0.046 . While extracapsular involvement significantly reduced the DFS and OS p=0.022, p=0.050, respectively , overall RT time affected DFS alone p=0.046 . Conclusion: We recommend adjuvant RT in high-risk patients operated due to a salivary gland tumor.

References

  • Licitra L, Grandi C, Prott FJ, Schornagel JH, Bruzzi P, Molinari R. Major and minor salivary glands tumours. Crit Rev Oncol Hematol 2003;45:215-25.
  • Armstrong JG, Harrison LB, Spiro RH, Fass DE, Strong EW, Fuks ZY. Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy. Arch Otolaryngol Head Neck Surg 1990;116:290-3.
  • Terhaard CH, Lubsen H, Rasch CR, Levendag PC, Kaanders HH, Tjho-Heslinga RE, et al. Dutch Head and Neck Oncology Cooperative Group.The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys 2005;61:103-11.
  • Garden AS, Weber RS, Ang KK, Morrison WH, Matre J, Peters LJ. Postoperative radiation therapy for malignant tumors of minor salivary glands. Outcome and patterns of failure. Cancer 1994;73:2563-9.
  • Wahlberg P, Anderson H, Biörklund A, Möller T, Perfekt R. Carcinoma of the parotid and submandibular glands--a study of survival in 2465 patients. Oral Oncol 2002;38:706-13.
  • Noh JM, Ahn YC, Nam H, Park W, Baek CH, Son YI, et al. Treatment results of major salivary gland cancer by surgery with or without postoperative radiation therapy. Clin Exp Otorhinolaryngol 2010;3:96-101.
  • Carrillo JF, Vázquez R, Ramírez-Ortega MC, Cano A, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Multivariate prediction of the probability of recurrence in patients with carcinoma of the parotid gland. Cancer 2007;109:2043-51.
  • Harbo G, Bundgaard T, Pedersen D, Sİgaard H, Overgaard J. Prognostic indicators for malignant tumours of the parotid gland. Clin Otolaryngol Allied Sci 2002;27:512-6.
  • Koul R, Dubey A, Butler J, Cooke AL, Abdoh A, Nason R. Prognostic factors depicting disease-specific survival in parotid-gland tumors. Int J Radiat Oncol Biol Phys 2007;68:714-8.
  • Lima RA, Tavares MR, Dias FL, Kligerman J, Nascimento MF, Barbosa MM, et al. Clinical prognostic factors in malignant parotid gland tumors. Otolaryngol Head Neck Surg 2005;133:702-8.
  • Kakarala K, Bhattacharyya N. Survival in oral cavity minor salivary gland carcinoma. Otolaryngology- Head and Neck Surgery 2010:143;122-6.
  • Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Keus RB, Hart AA. Stage as major long term outcome predictor in minor salivary gland carcinoma. Cancer 2000;89:1195-204.
  • Pedersen D, Overgaard J, Sİgaard H, Elbrİnd O, Overgaard M. Malignant parotid tumors in 110 consecutive patients: treatment results and prognosis. Laryngoscope 1992;102:1064-9.
  • Numata T, Muto H, Shiba K, Nagata H, Terada N, Konno A. Evaluation of the validity of the 1997 International Union Against Cancer TNM classification of major salivary gland carcinoma. Cancer 2000;89:1664-9.
  • Zbären P, Schüpbach J, Nuyens M, Stauffer E, Greiner R, Häusler R. Carcinoma of the parotid gland. Am J Sur 2003;186:57-62.
  • Bell RB, Dierks EJ, Homer L, Potter BE. Management and outcome of patients with malignant salivary gland tumors. J Oral Maxillofac Surg 2005;63:917-28.
  • Garden AS, el-Naggar AK, Morrison WH, Callender DL, Ang KK, Peters LJ. Postoperative radiotherapy for malignant tumors of the parotid gland. Int J Radiat Oncol Biol Phys 1997;37:79-85.
  • Chen AM, Granchi PJ, Garcia J, Bucci MK, Fu KK, Eisele DW. Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the majorsalivary glands: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 2007;67:982-7.
  • Zbären P, Nuyens M, Caversaccio M, Greiner R, Stauffer E. Postoperative radiation therapy for T1 and T2 primary parotid carcinoma: is it useful? Otolaryngol Head Neck Surg 2006;135:140-3.
  • Bjİrndal K, Krogdahl A, Therkildsen MH, Overgaard J, Johansen J, Kristensen CA, et al. Salivary gland carcinoma in Denmark 1990-2005: outcome and prognostic factors. Results of the Danish Head and Neck Cancer Group (DAHANCA). Oral Oncology 2012;48:179-85.
  • Terhaard CH, Lubsen H, Van der Tweel I, Hilgers FJ, Eijkenboom WM, Marres HA, et al. Dutch Head and Neck Oncology Cooperative Group.Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head Neck 2004;26:681-92.
  • Regezi JA, Batsakis JG. Histogenesis of salivary gland neoplasms.Otolaryngol Clin North Am 1977;10:297-307.
  • Oliveira LR, Soave DF, Oliveira-Costa JP, Zorgetto VA, Ribeiro-Silva A. Prognostic factors in patients with malignant salivary gland neoplasms in a Brazilian population. Asian a Pac J Cancer Prev 2011;12:363-8.
  • Renehan AG, Gleave EN, Slevin NJ, McGurk M. Clinico-pathological and treatment-related factors influencing survival in parotid cancer. Br J Cancer 1999;80:1296-300.
  • Godballe C, Schultz JH, Krogdahl A, Mİller-Grİntved A, Johansen J. Parotid carcinoma: impact of clinical factors on prognosis in a histologically revised series. Laryngoscope 2003;113:1411-7.
  • Matsuba HM, Thawley SE, Devineni VR, Levine LA, Smith PG. High-grade malignancies of the parotid gland: effective use of planned combined surgery and irradiation. Laryngoscope 1985;95:1059-63.
  • Tu G, Hu Y, Jiang P, Qin D. The superiority of combined therapy (surgery and postoperative irradiation) in parotid cancer. Arch Otolaryngol 1982;108:710-3.
  • Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Loftus-Coll BM, Keus RB, et al. The development of a prognostic score for patients with parotid carcinoma. Cancer 1999;85:2057-67.
  • Renehan A, Gleave EN, Hancock BD, Smith P, McGurk M. Long-term follow-up of over 1000 patients with salivary gland tumours treated in a single centre. Br J Surg 1996;83:1750-4.
  • Spiro RH, Armstrong J, Harrison L, Geller NL, Lin SY, Strong EW. Carcinoma of major salivary glands. Recent trends.Arch Otolaryngol Head Neck Surg 1989;115:316-21.
  • North CA, Lee DJ, Piantadosi S, Zahurak M, Johns ME. Carcinoma of the major salivary glands treated targets for postoperative radiochemotherapy? Head Neck 1998;20:588-94.
  • Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001;51:571-8.
  • Garden AS, Weber RS, Ang KK, Morrison WH, Matre J, Peters LJ. Postoperative radiation therapy for malignant tumors of minor salivary glands. Cancer 1994;73:2563-69.
  • Spiro RH. Distant metastasis in adenoid cystic carcinoma of salivary origin. Am J Surg 1997;174:495-8.
  • Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg 1991;162:330-6. and neck tumors based on RTOG #85-03 and #88-24:

Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız

Year 2014, Volume: 24 Issue: 6, 316 - 323, 25.12.2014

Abstract

Amaç: Bu çalışmada ameliyat sonrası radyoterapi RT alan tükürük bezi tümörlü hastalarda tek merkez deneyimimiz değerlendirildi.Hastalar ve Yöntemler: Ocak 1996 - Aralık 2011 tarihleri arasında ameliyat edilen ve adjuvan RT tedavisi için kliniğimize sevk edilen 34 tükürük bezi tümörlü hastanın dosyaları retrospektif olarak incelendi. Primer tümör veya lenfatiklerine 1.8-2 Gy/fraksiyonda medyan 60 Gy 54-70 Gy dozunda RT uygulandı.Bulgular: Medyan izlem süresi 38 aydı dağılım, 3-204 ay . Hastalık en sık 21 hastada %62 parotis bezinde, bunu takiben 11 hastada submandibüler bezde %24 ve iki hastada da minör tükürük bezinde %9 gözlendi. Beş yıllık genel sağkalım GSK %49 dağılım, 3-206 ay ve hastalıksız sağkalım HSK %61 dağılım, 1-173 ay idi. Altı hastada %18 lokal veya bölgesel nüks gelişirken 13 hastada %38 uzak organ metastazı gelişti. Tümör çapının 4 cm’den büyük olması ve RT’ye altı haftadan geç başlanması GSK için sırasıyla, p=0.023, p=0.039 , metastatik lenf nodu varlığı ise HSK için kötü prognostik faktörlerdi p=0.046 . Ekstrakapsüler tutulum varlığı HSK ve GSK’yi anlamlı düzeyde kısaltırken sırasıyla, p=0.022, p=0.050 , genel RT süresinin yalnızca HSK’yi etkilediği gözlendi p=0.046 .Sonuç: Tükürük bezi tümörü nedeniyle ameliyat edilen yüksek riskli hastalarda adjuvan RT’yi önermekteyiz

References

  • Licitra L, Grandi C, Prott FJ, Schornagel JH, Bruzzi P, Molinari R. Major and minor salivary glands tumours. Crit Rev Oncol Hematol 2003;45:215-25.
  • Armstrong JG, Harrison LB, Spiro RH, Fass DE, Strong EW, Fuks ZY. Malignant tumors of major salivary gland origin. A matched-pair analysis of the role of combined surgery and postoperative radiotherapy. Arch Otolaryngol Head Neck Surg 1990;116:290-3.
  • Terhaard CH, Lubsen H, Rasch CR, Levendag PC, Kaanders HH, Tjho-Heslinga RE, et al. Dutch Head and Neck Oncology Cooperative Group.The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys 2005;61:103-11.
  • Garden AS, Weber RS, Ang KK, Morrison WH, Matre J, Peters LJ. Postoperative radiation therapy for malignant tumors of minor salivary glands. Outcome and patterns of failure. Cancer 1994;73:2563-9.
  • Wahlberg P, Anderson H, Biörklund A, Möller T, Perfekt R. Carcinoma of the parotid and submandibular glands--a study of survival in 2465 patients. Oral Oncol 2002;38:706-13.
  • Noh JM, Ahn YC, Nam H, Park W, Baek CH, Son YI, et al. Treatment results of major salivary gland cancer by surgery with or without postoperative radiation therapy. Clin Exp Otorhinolaryngol 2010;3:96-101.
  • Carrillo JF, Vázquez R, Ramírez-Ortega MC, Cano A, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Multivariate prediction of the probability of recurrence in patients with carcinoma of the parotid gland. Cancer 2007;109:2043-51.
  • Harbo G, Bundgaard T, Pedersen D, Sİgaard H, Overgaard J. Prognostic indicators for malignant tumours of the parotid gland. Clin Otolaryngol Allied Sci 2002;27:512-6.
  • Koul R, Dubey A, Butler J, Cooke AL, Abdoh A, Nason R. Prognostic factors depicting disease-specific survival in parotid-gland tumors. Int J Radiat Oncol Biol Phys 2007;68:714-8.
  • Lima RA, Tavares MR, Dias FL, Kligerman J, Nascimento MF, Barbosa MM, et al. Clinical prognostic factors in malignant parotid gland tumors. Otolaryngol Head Neck Surg 2005;133:702-8.
  • Kakarala K, Bhattacharyya N. Survival in oral cavity minor salivary gland carcinoma. Otolaryngology- Head and Neck Surgery 2010:143;122-6.
  • Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Keus RB, Hart AA. Stage as major long term outcome predictor in minor salivary gland carcinoma. Cancer 2000;89:1195-204.
  • Pedersen D, Overgaard J, Sİgaard H, Elbrİnd O, Overgaard M. Malignant parotid tumors in 110 consecutive patients: treatment results and prognosis. Laryngoscope 1992;102:1064-9.
  • Numata T, Muto H, Shiba K, Nagata H, Terada N, Konno A. Evaluation of the validity of the 1997 International Union Against Cancer TNM classification of major salivary gland carcinoma. Cancer 2000;89:1664-9.
  • Zbären P, Schüpbach J, Nuyens M, Stauffer E, Greiner R, Häusler R. Carcinoma of the parotid gland. Am J Sur 2003;186:57-62.
  • Bell RB, Dierks EJ, Homer L, Potter BE. Management and outcome of patients with malignant salivary gland tumors. J Oral Maxillofac Surg 2005;63:917-28.
  • Garden AS, el-Naggar AK, Morrison WH, Callender DL, Ang KK, Peters LJ. Postoperative radiotherapy for malignant tumors of the parotid gland. Int J Radiat Oncol Biol Phys 1997;37:79-85.
  • Chen AM, Granchi PJ, Garcia J, Bucci MK, Fu KK, Eisele DW. Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the majorsalivary glands: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 2007;67:982-7.
  • Zbären P, Nuyens M, Caversaccio M, Greiner R, Stauffer E. Postoperative radiation therapy for T1 and T2 primary parotid carcinoma: is it useful? Otolaryngol Head Neck Surg 2006;135:140-3.
  • Bjİrndal K, Krogdahl A, Therkildsen MH, Overgaard J, Johansen J, Kristensen CA, et al. Salivary gland carcinoma in Denmark 1990-2005: outcome and prognostic factors. Results of the Danish Head and Neck Cancer Group (DAHANCA). Oral Oncology 2012;48:179-85.
  • Terhaard CH, Lubsen H, Van der Tweel I, Hilgers FJ, Eijkenboom WM, Marres HA, et al. Dutch Head and Neck Oncology Cooperative Group.Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head Neck 2004;26:681-92.
  • Regezi JA, Batsakis JG. Histogenesis of salivary gland neoplasms.Otolaryngol Clin North Am 1977;10:297-307.
  • Oliveira LR, Soave DF, Oliveira-Costa JP, Zorgetto VA, Ribeiro-Silva A. Prognostic factors in patients with malignant salivary gland neoplasms in a Brazilian population. Asian a Pac J Cancer Prev 2011;12:363-8.
  • Renehan AG, Gleave EN, Slevin NJ, McGurk M. Clinico-pathological and treatment-related factors influencing survival in parotid cancer. Br J Cancer 1999;80:1296-300.
  • Godballe C, Schultz JH, Krogdahl A, Mİller-Grİntved A, Johansen J. Parotid carcinoma: impact of clinical factors on prognosis in a histologically revised series. Laryngoscope 2003;113:1411-7.
  • Matsuba HM, Thawley SE, Devineni VR, Levine LA, Smith PG. High-grade malignancies of the parotid gland: effective use of planned combined surgery and irradiation. Laryngoscope 1985;95:1059-63.
  • Tu G, Hu Y, Jiang P, Qin D. The superiority of combined therapy (surgery and postoperative irradiation) in parotid cancer. Arch Otolaryngol 1982;108:710-3.
  • Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Loftus-Coll BM, Keus RB, et al. The development of a prognostic score for patients with parotid carcinoma. Cancer 1999;85:2057-67.
  • Renehan A, Gleave EN, Hancock BD, Smith P, McGurk M. Long-term follow-up of over 1000 patients with salivary gland tumours treated in a single centre. Br J Surg 1996;83:1750-4.
  • Spiro RH, Armstrong J, Harrison L, Geller NL, Lin SY, Strong EW. Carcinoma of major salivary glands. Recent trends.Arch Otolaryngol Head Neck Surg 1989;115:316-21.
  • North CA, Lee DJ, Piantadosi S, Zahurak M, Johns ME. Carcinoma of the major salivary glands treated targets for postoperative radiochemotherapy? Head Neck 1998;20:588-94.
  • Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001;51:571-8.
  • Garden AS, Weber RS, Ang KK, Morrison WH, Matre J, Peters LJ. Postoperative radiation therapy for malignant tumors of minor salivary glands. Cancer 1994;73:2563-69.
  • Spiro RH. Distant metastasis in adenoid cystic carcinoma of salivary origin. Am J Surg 1997;174:495-8.
  • Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg 1991;162:330-6. and neck tumors based on RTOG #85-03 and #88-24:
There are 35 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Candan Demiroz Abakay This is me

Kadriye Şahintürk This is me

Ali Türk This is me

Lütfi Özkan This is me

Afşin Özmen This is me

Publication Date December 25, 2014
Published in Issue Year 2014 Volume: 24 Issue: 6

Cite

APA Demiroz Abakay, C., Şahintürk, K., Türk, A., Özkan, L., et al. (2014). Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız. The Turkish Journal of Ear Nose and Throat, 24(6), 316-323.
AMA Demiroz Abakay C, Şahintürk K, Türk A, Özkan L, Özmen A. Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız. Tr-ENT. December 2014;24(6):316-323.
Chicago Demiroz Abakay, Candan, Kadriye Şahintürk, Ali Türk, Lütfi Özkan, and Afşin Özmen. “Tükürük Bezi Kanserli Olgularda Ameliyat Sonrası Radyoterapi sonuçlarımız”. The Turkish Journal of Ear Nose and Throat 24, no. 6 (December 2014): 316-23.
EndNote Demiroz Abakay C, Şahintürk K, Türk A, Özkan L, Özmen A (December 1, 2014) Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız. The Turkish Journal of Ear Nose and Throat 24 6 316–323.
IEEE C. Demiroz Abakay, K. Şahintürk, A. Türk, L. Özkan, and A. Özmen, “Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız”, Tr-ENT, vol. 24, no. 6, pp. 316–323, 2014.
ISNAD Demiroz Abakay, Candan et al. “Tükürük Bezi Kanserli Olgularda Ameliyat Sonrası Radyoterapi sonuçlarımız”. The Turkish Journal of Ear Nose and Throat 24/6 (December 2014), 316-323.
JAMA Demiroz Abakay C, Şahintürk K, Türk A, Özkan L, Özmen A. Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız. Tr-ENT. 2014;24:316–323.
MLA Demiroz Abakay, Candan et al. “Tükürük Bezi Kanserli Olgularda Ameliyat Sonrası Radyoterapi sonuçlarımız”. The Turkish Journal of Ear Nose and Throat, vol. 24, no. 6, 2014, pp. 316-23.
Vancouver Demiroz Abakay C, Şahintürk K, Türk A, Özkan L, Özmen A. Tükürük bezi kanserli olgularda ameliyat sonrası radyoterapi sonuçlarımız. Tr-ENT. 2014;24(6):316-23.