Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer

Patel, Aman M.; Haleem, Afash; Maxwell, Russell; Lukens, John N.; Lin, Alexander; Brody, Robert M.; Brant, Jason A.; Carey, Ryan M.

doi:10.1002/lary.31352

Cited by 5 publications

(2 citation statements)

References 64 publications

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“…16 Neck dissection was defined as the removal and examination of ≥10 lymph nodes, a validated threshold in head and neck cancer. 35,[44][45][46][47] aRT was defined as the delivery of therapeutic doses (44-70 Gy) of external beam radiation to the head and neck within 90 days of surgery. 11,16 aCRT was defined as the delivery of any chemotherapy, regardless of the type or number of agents, within 14 days of aRT initiation.…”

Section: Variablesmentioning

confidence: 99%

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

Patel,

Haleem,

Choudhry

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo investigate adjuvant therapy indications, utilization, and associated survival disparities in major salivary gland cancer (MSGC).Study DesignRetrospective cohort study.SettingThe 2006 to 2017 National Cancer Database.MethodsPatients with surgically resected MSGC were included (N = 11,398). pT3‐4 classification, pN2‐3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and positive surgical margin (PSM) were considered indications for adjuvant radiotherapy (aRT). pENE and PSM were considered possible indications for adjuvant chemotherapy. Multivariable logistic and Cox regression models were implemented.ResultsAmong 6694 patients with 1 indication for aRT, 1906 (28.5%) received no further treatment and missed aRT. Age, race, comorbidity status, facility type, and distance to reporting facility were associated with missed aRT (P < .025). Among 4003 patients with ≥1 possible indication for adjuvant chemoradiotherapy (aCRT), 914 (22.8%) received aCRT. Patients with pENE only (38.5%) and both pENE and PSM (44.0%) received aCRT more frequently than those with PSM only (17.0%) (P < .001). Academic facility was associated with aCRT utilization (P < .05). aCRT utilization increased between 2006 and 2017 in both academic (14.8% vs 23.9%) and nonacademic (8.8% vs 13.5%) facilities (P < .05). Among 2691 patients with ≥1 indication for aRT alone, missed aRT portended poorer OS (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.28‐2.03, P < .001). Among 4003 patients with ≥1 possible indication for aCRT, aRT alone (HR: 1.02, 95% CI: 0.89‐1.18, P = .780) and aCRT were associated with similar OS.ConclusionMissed aRT in MSGC occurs frequently and portends poorer OS. Further studies clarifying indications for aCRT are required.

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Section: Variablesmentioning

confidence: 99%

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

Patel,

Haleem,

Choudhry

et al. 2024

Otolaryngol.--head neck surg.

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“…END was defined as the removal and examination of ≥10 lymph nodes, a threshold validated by previous studies of the NCDB (Figure 2). 10,20,[33][34][35][36][37] Adjuvant radiotherapy (aRT) was defined as the receipt of therapeutic doses (44-70 Gy) of external beam radiation to the head and neck. The primary outcome of our study was 5-year overall survival (OS).…”

Section: Variablesmentioning

confidence: 99%

Elective Neck Dissection in cT1‐4 N0M0 Head and Neck Basaloid Carcinoma

Patel,

Haleem,

Choudhry

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1‐4 N0M0 head and neck basaloid carcinoma (HNBC).Study DesignRetrospective cohort study.SettingThe 2006 to 2017 hospital‐based National Cancer Database.MethodsPatients with surgically resected cT1‐4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan‐Meier, and Cox proportional hazards regression models were implemented.ResultsOf 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1‐2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1‐2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3‐4 disease (66.7% vs 57.9%, R2 = .062). One‐hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5‐year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57‐0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71‐1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78‐1.61, P = .551) were not associated with OS.ConclusionEND is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.

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Facility Volume and Changing Facilities for Postoperative Radiotherapy in Salivary Gland Cancer

Patel,

Revercomb

et al. 2024

The Laryngoscope

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ObjectivesChanging location of postoperative radiotherapy (PORT) after treatment at a high‐volume facility (HVF) is associated with worse survival in various head and neck cancers. Our study investigates this relationship in salivary gland cancer (SGC).MethodsThe 2004–2016 National Cancer Database was queried for all cases of adult SGC treated with surgery and PORT with or without adjuvant chemotherapy. Patients with multiple cancer diagnoses, metastatic disease, or unknown PORT facility were excluded. Reporting facilities with >95th percentile annual case volume were classified as HVFs, the remainder were classified low‐volume facilities (LVFs).ResultsA total of 7885 patients met inclusion criteria, of which 418 (5.3%) were treated at an HVF. Patients treated at an HVF had higher rates clinical nodal positivity (18.2% vs. 14.0%, p < 0.001) and clinical T3/T4 (27.3% vs. 20.7%, p = 0.001) disease. Patients at HVFs changed facility for PORT at lower rates (18.9% vs. 24.5%, p = 0.009). Patients treated at an HVF had higher 5‐year overall survival (5‐OS) than those treated at an LVF (79.0% vs. 72.0%, p = 0.042). Patients treated at an HVF that changed PORT facility had worse 5‐OS (60.8% vs. 83.2%, p < 0.001). Radiation facility change was an independent predictor of worse survival in patients treated at an HVF (HR: 8.99 [3.15–25.67], p < 0.001) but not for patients treated at a LVF (HR: 1.11 [0.98–1.25], p = 0.109).ConclusionsPatients treated at an HVF changing facility for PORT for SGC experience worse survival. Our data suggest patients treated surgically at an HVF should be counseled to continue their PORT at the same institution.Level of Evidence3 Laryngoscope, 2024

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Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer

Cited by 5 publications

References 64 publications

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

Elective Neck Dissection in cT1‐4 N0M0 Head and Neck Basaloid Carcinoma

Facility Volume and Changing Facilities for Postoperative Radiotherapy in Salivary Gland Cancer

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