Incompletely treated malignancies of the major salivary gland: Toward evidence‐based care

Tam, Samantha; Sandulache, Vlad C.; Metwalli, Kareem A.; Rock, Crosby D.; Eraj, S.; Sheu, Tommy; El‐Naggar, Adel K.; Fuller, Clifton D.; Weber, Randal S.; Lai, Stephen Y.

doi:10.1002/hed.25156

Cited by 8 publications

(8 citation statements)

References 12 publications

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“…A previous study analyzed retrospectively their patients with incompletely treated major salivary gland tumors and found that failure to achieve gross total resection during initial surgery resulted in worse overall survival. 11 Moreover, gross residual disease was an independent predictor in these cases. Similarly, multivariate analyses of both LRC and DDFS showed that gross residual disease was an important risk factor in this study.…”

Section: Discussionmentioning

confidence: 85%

Radiotherapy as salvage treatment of salivary duct carcinoma in major salivary glands without radical operations

Qian

et al. 2018

CMAR

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BackgroundSalivary duct carcinoma (SDC) is an extremely rare and highly malignant carcinoma, and surgical radical resection is the most effective therapy. However, there were quite a proportion of patients receiving non-radical resections, and how to treat them remained controversial. Thus, the aim of this study is to evaluate whether postoperative radiotherapy could be a salvage treatment of SDC in major salivary glands without radical operations.Patients and methodsWe identified 40 pathologically diagnosed SDC patients who came to our hospital and did not receive radical operations. Thirty-three patients received at least one treatment (remedial operation, postoperative radiotherapy and chemotherapy), and seven patients only chose observation and received no further treatment. The prognostic indicators of the local–regional control (LRC) and distant disease-free survival were analyzed using the Kaplan–Meier methods and the Cox proportional hazards regression models.ResultsThirteen patients experienced local–regional recurrence or local progression, and distant metastases were observed in 15 patients. Through multivariate analysis, we found that postoperative radiotherapy was associated with better LRC, but this kind of treatment did not show significant efficacy in the prevention of distant metastasis.ConclusionSDC is a rare, aggressive malignancy, and a substantial proportion of these patients experienced inadequate initial treatments. Although postoperative radiotherapy could not decrease distant metastases, it might help to improve LRC in patients with SDC.

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Section: Discussionmentioning

confidence: 85%

Radiotherapy as salvage treatment of salivary duct carcinoma in major salivary glands without radical operations

Qian

et al. 2018

CMAR

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“…In that respect, in a recent large study including 440 patients with incompletely treated major salivary gland tumors, positive or close margins did not play any prognostic role for locoregional recurrence. 6 In fact, the prognostic role of surgical margins seems to be significant only in case of invaded margins. 10 Likewise, Mantsopoulos et al 11 analyzed 25 cases of revision parotidectomy after positive/close margins and found tumor residue in only 12% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there is little evidence in literature to guide therapeutic strategy. 2,5,6 For some authors, revision surgery must be systematic to prevent local recurrences and remove potential intraparotid metastases. 4 But this attitude leads to a higher risk of postoperative facial palsy (FP) (15%-40% definitive FP vs 1% for first-line excisions), 6 while related oncological results improvement is not precisely known.…”

Section: Introductionmentioning

confidence: 99%

“…2,5,6 For some authors, revision surgery must be systematic to prevent local recurrences and remove potential intraparotid metastases. 4 But this attitude leads to a higher risk of postoperative facial palsy (FP) (15%-40% definitive FP vs 1% for first-line excisions), 6 while related oncological results improvement is not precisely known. Thus, in some situations, completion revision surgery could constitute over-treatment with an unjustified high risk of FP.…”

Section: Introductionmentioning

confidence: 99%

“…But since these tumors are rare, there are few studies on this subject. [5][6][7][8] The main objective of the present study was to determine the frequency of situations in which systematic surgical revision led to the excision of an actual residual tumor. We also aimed at identifying clinical, radiological, or histological criteria that could help in predicting these situations.…”

Section: Introductionmentioning

confidence: 99%

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Is Revision Surgery Necessary for Patients With High Risk of Recurrence After Parotidectomy? A Multicenter Retrospective Study

Roch¹,

Mauvais

Vergez³

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: Close margin is a frequent situation after parotidectomy. The need for systematic prophylactic revision surgery is a question that arises regularly for malignant tumors, as it exposes to a high risk of facial palsy, while oncological benefits are unclear. Study Design: retrospective study. Setting: Multicentric. Subjects and Methods: We included all patients operated for systematic revision surgery in case of close margins after parotidectomy for a malignant tumor and analyzed the rate of tumor residue and its risk factors. Results: A tumor residue was identified in 43.5% of 23 cases, but none in case of initial complete excision with supra-millimetric margins. Invaded lymph nodes were identified in 6 cases, but none in case of low-grade tumors. Conclusions: Systematic revision seems mandatory in case of infra-millimetric margins and high-grade tumors or positive lymph node; further studies are needed to confirm whether it can be spared for T1-T2/N0 low-grade tumors, with close margins but complete initial excision.

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Stratégie chirurgicale devant une tumeur parotidienne et devant une tumeur submandibulaire

Chevalier¹

2020

Pathologies Des Glandes Parotides Et Submandibulaires De l'Adulte Et De l'Enfant

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Incompletely treated malignancies of the major salivary gland: Toward evidence‐based care

Abstract: Failure to achieve gross total resection during initial surgery resulted in worse OS. Adequate preoperative planning is required for initial surgical management to optimize tumor control and survival.

Cited by 8 publications

References 12 publications

Radiotherapy as salvage treatment of salivary duct carcinoma in major salivary glands without radical operations

Radiotherapy as salvage treatment of salivary duct carcinoma in major salivary glands without radical operations

Is Revision Surgery Necessary for Patients With High Risk of Recurrence After Parotidectomy? A Multicenter Retrospective Study

Stratégie chirurgicale devant une tumeur parotidienne et devant une tumeur submandibulaire

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