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Strahlentherapie und Onkologie

, Volume 195, Issue 12, pp 1050–1059 | Cite as

Outcome and management of rare high-grade “salivary” adenocarcinoma: the important role of adjuvant (chemo)radiotherapy

  • Claudia ScherlEmail author
  • Marlen Haderlein
  • Abbas Agaimy
  • Konstantinos Mantsopoulos
  • Michael Koch
  • Maximilian Traxdorf
  • Rainer Fietkau
  • Philipp Grundtner
  • Heinrich Iro
Original Article

Abstract

Purpose

To determine survival and management strategies for high-grade adenocarcinoma of salivary glands (ASG).

Methods

A retrospective analysis of cases diagnosed between 1998 and 2015 from our single tertiary referral center was performed. Multivariable logistic regression was used to determine factors associated with survival.

Results

Thirty-eight cases of high-grade ASG were identified. Most patients were men (68.4%) with a median age of 65.5 years (range 23–84 years). Most tumors were T3 and T4 (65.8%). Regional metastases were common (55.2%), and 42.1% developed distant metastases. The mean follow-up was 60.5 months. All patients received surgery as primary treatment, with 84.2% of patients receiving adjuvant radiation therapy or chemoradiotherapy ([C]RT). Cumulative overall survival was 89.1%, 50.9%, and 20.7% after 1, 5, and 10 years, respectively. Disease-specific survival was 94.4%, 69.8%, and 42.8%, and distant-metastases-free survival (DMFS) was 80.5%, 50.1%, and 40.1% after 1, 5, and 10 years. On multivariable analysis, advanced T status correlated with DMFS (hazard ratio 2.75, 95% CI 0.93–8.16). Postsurgical (C)RT reduced the locoregional recurrence rate by 23.9%, and it improved the locoregional-recurrence-free survival by 39% (p = 0.094).

Conclusion

High-grade ASG is considered to have an unfavorable prognosis. Adjuvant (C)RT reduces the rate of locoregional recurrences. Distant metastases are common, and an advanced T stage has increased prognostic value for development of early distant lesions.

Keywords

Salivary gland cancer Salivary gland malignancy Head and neck cancer Survival salivary gland cancer Treatment salivary gland cancer 

Ergebnisse und Behandlung der seltenen gering differenzierten Adenokarzinome der Speicheldrüsen: wichtige Rolle der adjuvanten (Chemo)radiotherapie

Zusammenfassung

Ziel

Untersuchung von Überleben und Behandlungsstrategien von gering differenzierten Adenokarzinomen der Speicheldrüsen (ASG).

Methoden

Es wurde eine retrospektive Analyse von Fällen durchgeführt, die zwischen 1998 und 2015 in unserer Universitätsklinik behandelt wurden. Faktoren, die mit dem Überleben assoziiert waren, wurden in einer multivariablen Regressionsanalyse bestimmt.

Ergebnisse

Insgesamt wurden 38 schlecht differenzierte ASG identifiziert. Die meisten Patienten waren männlich (68,4%) mit einem mittleren Alter von 65,5 Jahren (Zeitspanne: 23–84 Jahre). Die meisten Tumoren wiesen einen T3- und T4-Status auf (65,8%). Regionäre Metastasen waren häufig (55,2%); 42,1% entwickelten Fernmetastasen. Die mittlere Nachsorgezeit betrug 60,5 Monate. Bei allen Patienten wurde eine primär chirurgische Therapie durchgeführt. Insgesamt 84,2% der Patienten erhielten eine adjuvante Radiatio oder eine Radiochemotherapie ([C]RT). Das kumulative Gesamtüberleben (OS) betrug 89,1, 50,9 und 20,7% nach 1, 5 und 10 Jahren. Das krankheitsspezifische Überleben (DSS) und das fernmetastasenfreie Überleben (DMFS) waren 94,4%, 69,8%, 42,1% und 80,5%, 50,1%, 40,1% nach 1, 5 und 10 Jahren. In der multivariaten Analyse war ein fortgeschrittenes T‑Stadium mit dem DMFS korreliert (HR: 2,75; 95% KI 0,93–8,16). Eine adjuvante (C)RT reduzierte die lokoregionäre Rezidivrate um 23,9% und verbesserte das lokoregionäre rezidivfreie Überleben um 39% (p = 0,094).

Schlussfolgerung

Gering differenzierte ASG weisen eine schlechte Prognose auf. Eine adjuvante (C)RT reduziert die Rate an lokoregionären Rezidiven. Fernmetastasen sind häufig, und ein fortgeschrittener T‑Status hat einen hohen prognostischen Wert bei der Entwicklung von Fernmetastasen.

Schlüsselwörter

Speicheldrüsenkarzinom Speicheldrüsenmalignität Kopf-Hals-Karzinome Überleben Speicheldrüsenkarzinom Behandlung Speicheldrüsenkarzinom 

Notes

Compliance with ethical guidelines

Conflict of interest

C. Scherl, M. Haderlein, A. Agaimy, K. Mantsopoulos, M. Koch, M. Traxdorf, R. Fietkau, P. Grundtner, and H. Iro declare that they have no competing interests.

Ethical standards

For this type of study, formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Claudia Scherl
    • 1
    Email author
  • Marlen Haderlein
    • 2
  • Abbas Agaimy
    • 3
  • Konstantinos Mantsopoulos
    • 1
  • Michael Koch
    • 1
  • Maximilian Traxdorf
    • 1
  • Rainer Fietkau
    • 2
  • Philipp Grundtner
    • 1
  • Heinrich Iro
    • 1
  1. 1.Department of Otolaryngology, Head and Neck SurgeryFriedrich-Alexander-University (FAU)ErlangenGermany
  2. 2.Department of Radiation OncologyFriedrich-Alexander-University (FAU)ErlangenGermany
  3. 3.Department of PathologyFriedrich-Alexander-University (FAU)ErlangenGermany

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