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

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.

Inhibition of HDAC and Signal Transduction Pathways Induces Tight Junctions and Promotes Differentiation in p63-Positive Salivary Duct Adenocarcinoma

“…Salivary gland cancer is a rare malignancy that includes more than 20 subtypes according to the WHO 2017 classification of head and neck cancers [ 1 , 2 ]. While head and neck cancers are predominantly squamous cell carcinomas, salivary gland cancers are predominantly adenocarcinomas.…”

Chaotic transformation of parotid acinic cell carcinoma to metastatic dedifferentiated high-grade pathology - A rare case with clinical and emotional challenge

“…Salivary gland cancers (SGC) are rare and affect between 0.6 and 1.4 people per 100,000 [ 8 ]. They are a diverse group of tumors with multiplex clinicopathological features and typical biological behaviour.…”

Surgical Treatment of Carcinomas of the Oral Minor Salivary Glands—Oncological Outcome in Dependence of Tumor Entity and Therapeutic Strategies

“…While surgical resection of the primary tumor, potentially complemented by adjuvant radiotherapy has been described as a therapeutic standard algorithm, a recommendation regarding the treatment of the clinically negative neck remains vague and contradictory and a differentiation of treatment recommendations adapted to the different tumor entities is missing so far [14,23,24].…”