Adenoid Cystic Carcinoma of the Salivary Glands: A Review of 10 Years

Abstract

A retrospective analysis was performed of 50 patients with adenoid cystic carcinoma who were seen in the Department of Radiation Oncology, University of Witwatersrand, Johannesburg, South Africa, in the past 10 years. There were 25 men and 25 women with a mean age of 52 years (age range, 21 to 88 years). Five patients had metastatic disease, and 17 had neural invasion. Thirty-four patients had surgery (11, complete; 23, microscopic residual). Sixteen patients had radiotherapy as initial management. The disease-free survival was 26%, overall survival was 29%, and local control was 30% at 10 years. Most recurrences occurred in the first 3 years. Nine patients had metastasis following treatment. The mean survival after metastasis was 15 months. Seven prognostic variables were analyzed using the log-rank test. There was no impact of age, site, type of salivary gland (major vs. minor), tumor stage, node positivity, or neural invasion on disease-free survival, overall survival, or local control. Extent of surgical resection (complete vs. microscopic residual) had a significant impact on disease-free survival and local control (P < 0.05) but no impact on overall survival (P > 0.05) because of the slow-growing nature of these tumors. Similarly, patients who had microscopic residual after surgery and were treated with radiotherapy did better than those who had biopsy and radiotherapy, although this was not significant statistically (P > 0.05). Thus, whenever possible, every attempt must be made to remove all microscopic tumor by surgery. Addition of postoperative radiotherapy with high-energy photons did not improve the locoregional control or survival in our series. There is a place for neutrons in the treatment of adenoid cystic carcinomas in advanced cases of inoperable or recurrent tumors, as a review of literature shows.

Adenoid cystic carcinoma: A review of recent advances, molecular targets, and clinical trials

“…Patients who develop metastatic ACC are considered incurable, except in the rare case in which single or oligometastatic disease is resectable 38. Of those with disseminated disease, patients who have metastases limited to the lung survive longer than those with bone or other visceral metastases 47. It is also important to note that although ACC in the breast can seem initially like invasive ductal carcinoma and is typically triple negative (estrogen receptor, progesterone receptor, and HER‐2) it has a generally more favorable prognosis than conventional triple negative breast carcinomas and ACCs arising at other sites.…”

Adenoid Cystic Carcinoma of Head and Neck: Clinical Predictors of Outcome from a Canadian Centre

“…Surgery, the traditional mainstay of treatment for localized acc, results in improved survival [5][6][7][8] nodes 4,[9][10][11] . In cases in which surgery is not possible, radiotherapy alone has been used, but with inferior results 8,[12][13][14][15][16][17][18] .…”

Chemokine receptors in head and neck cancer: Association with metastatic spread and regulation during chemotherapy

“…1,2 Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor, arising from salivary glands. 3 Both tumor types are characterized by distinct metastatic patterns. While SCC frequently metastasizes to regional lymph nodes, ACC is more aggressive, disseminating to distant sites, particularly, the lung and the liver.…”