Patterns of nodal involvement for clinically N0 salivary gland carcinoma: Refining the role of elective neck irradiation

Abstract

The likelihood of occult cervical lymph node metastasis for patients with salivary gland carcinoma is driven predominantly by histological subtype. Implications for elective neck irradiation are discussed.

Management of salivary gland carcinomas - a review

“…The cervical metastases rates of low-, intermediate-, and high-grade tumors were 0%, 10%, and 35%, respectively. [44] Schramm and Imola also found a 47% rate of occult metastasis in clinically node-negative necks (Eight of 14 had poorly-differentiated tumors). [16] Due to relatively high rate of occult neck involvement, Liu et al also indicated that elective neck treatment included neck resection and radiotherapy was also recommended for patients with cervical negative lymph node, especially for high grade tumors.…”

What is the role of elective neck dissection in low‐, intermediate‐, and high‐grade mucoepidermoid carcinoma?

“…These varying criteria impose an additional challenge in the interpretation MEC data. Each of the three previously referenced studies, for example, implemented different criteria: Armstrong et al did not specify how grade was assessed and might be assumed to have used subjective grading, whereas Santos et al and Lau et al utilized the WHO and AFIP criteria, respectively . Despite their differences, each of these grading techniques has been validated in its ability to predict tumor behavior.…”

“…Each of the three previously referenced studies, for example, implemented different criteria: Armstrong et al did not specify how grade was assessed and might be assumed to have used subjective grading, 1 whereas Santos et al and Lau et al utilized the WHO and AFIP criteria, respectively. 2,3 Despite their differences, each of these grading techniques has been validated in its ability to predict tumor behavior. As such, it is possible to justify the interpretation of clinical data relying on differing grading schemes, provided that the potential for confounding variables is recognized.…”

Predictors of outcomes in large cell undifferentiated carcinoma of the major salivary glands

“…Recent analysis of parotid tumors in the NCDB examined occult disease‐differentiated parotid carcinomas and reported 25% occult nodal disease in high‐grade lesions overall, with a maximal rate of 36% found in high‐grade salivary ductal carcinoma . Most authors agree that elective treatment of the neck is indicated for high‐grade salivary gland malignancies . In this series, a negligible number (< 2%) of LCUC cancers were not classified as high grade.…”

“…Several previous studies have found histologic subtype and grade to be the key predictors of occult nodal disease in salivary malignancies. 21,22 Recent analysis of parotid tumors in the NCDB examined occult disease-differentiated parotid carcinomas and reported 25% occult nodal disease in high-grade lesions overall, with a maximal rate of 36% found in high-grade salivary ductal carcinoma. 22 Most authors agree that elective treatment of the neck is indicated for high-grade salivary gland malignancies.…”